Preamble

The House met at half-past Two o'clock

PRAYERS

[MADAM SPEAKER in the Chair]

Oral Answers to Questions — NORTHERN IRELAND

Republic of Ireland Government

Mr. Devlin: To ask the Secretary of State for Northern Ireland when he last met the Foreign Minister of the Republic of Eire; and if he will make a statement.

Mr. Corbett: To ask the Secretary of State for Northern Ireland what recent discussions he has had with the Government of the Republic of Ireland relating to Northern Ireland.

The Secretary of State for Northern Ireland (Sir Patrick Mayhew): I last met the Irish Foreign Minister, Mr. Spring, on 15 December 1993, when my right hon. Friend the Prime Minister and the Taoiseach made their joint declaration. Since then, we have been working within the framework set out in that declaration to carry forward the talks process involving the constitutional political parties as well as the two Governments. We remain in close contact.

Mr. Devlin: Does my right hon. and learned Friend agree that the joint declaration is a fair arrangement for the future and that it is now up to the IRA and other organisations to renounce violence for good and come to the negotiating table?

Sir Patrick Mayhew: I warmly agree with my hon. Friend. The joint declaration document sets out and recognises the rights, interests and aspirations of both communities and the safeguards by which they might be protected. It is founded on the fundamental principles of consent, agreement and democracy. It is not a final settlement—it does not pretend to be. It provides a framework for peace. As such, the declaration and the realities affirmed in it will stand. My hon. Friend is absolutely right. Those who perpetrate violence and those who justify violence should renounce it once and for all, and for good.

Mr. Corbett: Given that there are now two sets of documents on the secret line of communication between the Government and Sinn Fein, will the Secretary of State confirm that, earlier, the British Government were willing to clarify their position to Sinn Fein? Given also that the Prime Minister described the Downing street declaration as a framework for peace, why are the Government refusing

to clarify their position again to Sinn Fein, short, of course, of full negotiations until, as the Secretary of State says, there is a clear renunciation of violence?

Sir Patrick Mayhew: The Government were prepared to clarify their thinking quite a long time before receiving the message of 22 February, which was the outset of the exchange of documents authorised by the Government and received by the Government, which were included in the dossier that I subsequently published. A very different situation now obtains. The joint declaration is the result of careful discussion between the two Governments. Those Governments considered it for a matter of months. There is no justification now for entering upon a process of clarification of its contents; that would inevitably lead to a renegotiation, a glossing of it and an interpretation of it. That is a very different matter. Sinn Fein should now agree to a renunciation of violence and of the justification of violence, and it should then enter the process that leads to the exploratory talks, which I set out in a statement on the matter in November.

Mr. Peter Robinson: If the Provisional IRA does not accept the offer contained in and through the Downing street declaration and instead continues its violence, will any of the provisions of the Downing street declaration collapse as a result?

Sir Patrick Mayhew: No. The Downing street declaration is a statement, as I have just suggested to the House, of the fundamental realities and principles that govern relationships in Northern Ireland, the future of Northern Ireland and the future of the island of Ireland in the view of the two Governments. Therefore, they will stand. I should like to make it absolutely clear that nothing is waiting upon the answer that Sinn Fein and the Provisional IRA should give. We are continuing to pursue them through the security forces and within the law with the full vigour that their crimes demand. Similarly, the talks process is continuing under the guidance of my hon. Friend the Member for Devizes (Mr. Ancram), the Minister of State. It is business as usual. The question at issue is whether Sinn Fein decides to join that process, and that is for it. If it wants to do so, it must renounce violence.

Rev. Martin Smyth: In his conversation with the Foreign Minister of the Irish Republic, did the Secretary of State impress on him the need to reform its constitution, because in the modern world it is utterly unreal and improper to obtain territorial possession of a neighbouring territory? It has been the cause of problems over the years, and it gives a moral impetus to the IRA, as its members claim to be freedom fighters.

Sir Patrick Mayhew: Mr. Spring and his colleagues are under no illusion about the strong significance that is seen in articles 2 and 3 of the Irish constitution. There is a reference to the referendum that would be held in the event of an overall settlement. In the joint declaration, the Taoiseach says that the Government would then bring forward and support proposals that reflect the principle of consent in Northern Ireland, and that is a clear reference to articles 2 and 3.

Mr. Couchman: When my right hon. and learned Friend met the Irish Foreign Minister, did he have an opportunity to discuss the ban on the broadcasting of interviews with Sinn Fein and paramilitary groups in the


Republic? Did he ask whether the Irish Government had it in mind to let that ban lapse? Did he further ask what impact they thought that that might have on the similar ban that prevails in this country?

Sir Patrick Mayhew: As I said, I last met the Irish Foreign Minister when the declaration was signed, and to the best of my recollection that matter was not discussed. We have made known our views about the importance of maintaining our legislation, and we were not told about the decision that the Irish Government proposed to take. Our position remains that it is important that people should be spared the additional grief and gall of listening to people justify acts of inhuman violence when they have to suffer those acts in Northern Ireland. It is known that my right hon. Friend the Heritage Secretary has the matter under review.

Mr. Mallon: In all the concentration on Sinn Fein and the IRA, it might be as well to remind the House that the vast majority of the nationalist people in the north of Ireland do not support Sinn Fein, the IRA or violence. The Prime Minister has said that the Downing street declaration is a balanced document and is fair to each section of the community, and I agree with him. Does the Secretary of State accept that if it is a balanced document, the Government's presentation should also be balanced? If he examines carefully the comments made by the Prime Minister, by himself and by other Ministers, can he honestly say that they have been sensitive to the position and the needs of both sections of the community? In recognising that imbalance, will he take this opportunity to ask the Prime Minister to remember that an unbalanced presentation of the declaration can go a long way to affect the chances of peace in Northern Ireland? I ask him again to remember that there are two sections within that community, each with its own needs and sensitivities.

Sir Patrick Mayhew: I do not think that anybody is likely to forget that there are two sections within that community. It is from that feature and that factor that so many of the difficulties and problems derive. I do not think that there is anything in the way in which my right hon. Friend or I have described the agreement for which we should apologise. What we have said and insisted on is that the agreement speaks for itself. We have been careful not to interpret or put a gloss on any of its terms, for the sensible reasons that I gave the House a few moments ago. Later today, I shall be delivering a lecture, the text of which I shall publish. I hope that it will be seen as giving a fair and balanced account of the joint declaration.

Mr. McNamara: During Prime Minister's Question Time last week, he said that he and the Secretary of State
have gone to great lengths in this House and beyond it to ensure that the joint declaration is fully understood and we shall, of course, continue to do so.
Yet, in answer to another question, the Prime Minister said:
we are not in the business of clarifying the declaration."—[Official Report, 13 January 1994; Vol. 235, c. 330–34.]
Will the Secretary of State explain the difference between clarification and promoting full understanding?

Sir Patrick Mayhew: Promoting full understanding is well served by pointing out to people that the declaration has been extremely well drafted and carefully considered, and that it bears close examination. It would be a great mistake to enter into interpretations and say, "When it says

this on the face of it, it actually means something else." If one does that, the process degenerates quickly and inevitably into one of negotiation. That is a great mistake, and is of no service to anyone.
We see no need for clarification. We see dangers in it for the reasons that I have suggested. Those reasons argue against clarification, and we do not intend to give any. The topic of clarification could be brought forward in the hope that it will serve to muddy the waters and distract attention from the real question that needs to be answered and clarified by Sinn Fein and by the Provisional IRA—will they now give up violence for good? The leader of the Social Democratic and Labour Party, the hon. Member for Foyle (Mr. Hume), has said—I will paraphrase him—that any reason that the IRA might conceivably have had for using violence has been removed by the declaration.

Higher Education

Mr. John Marshall: To ask the Secretary of State for Northern Ireland if he will make a statement about the number of students entering higher education in Northern Ireland in 1993–94.

The Minister of State, Northern Ireland Office (Mr. Michael Ancram): Approximately 16,000 students entered higher education in Northern Ireland in 1993–94. This represents an 8 per cent. increase on the previous year's intake.

Mr. Marshall: I congratulate my hon. Friend upon his well-deserved promotion. Does he agree that the fact that the proportion of students entering higher education in Northern Ireland is greater than in the country as a whole reflects well upon the Northern Ireland education system? Does he also agree that the upsurge in the number of students entering higher education gives the lie to the absurd forecasts that the introduction of the student loan system would lead to fewer people doing so?

Mr. Ancram: I thank my hon. Friend for his kind remarks, and I totally agree with what he said. It is worth reminding ourselves that an estimated 39 per cent. of young people in Northern Ireland enter higher education, compared with an estimated 31 per cent. in Great Britain. Those are the figures for 1993–94. As my hon. Friend so rightly said, the figures show the results of the high-quality education that is provided within the Province.

Mr. Beggs: I, too, welcome the Minister to the post to which he has been promoted. I trust that he will not be too speedily promoted yet again.
The Minister will be well aware from statistics from the Department of Education for Northern Ireland that 44·8 per cent. of students in Northern Ireland depend on student grants and are in receipt of no parental contribution. Is he aware that many young graduates in Northern Ireland do not earn anything near £14,000 per annum, and that it will be a long time before they are in a position to repay student loans and to reach the national average for earnings? Will he monitor closely future enrolment, especially the impact of the 10 per cent. cut in student grants? Will he seek to ensure that Northern Ireland's young people have the opportunity to realise their full academic potential without the burden of too-heavy loans?

Mr. Ancram: I am grateful for the hon. Gentleman's kind remarks. The questions of promotion are not for me,


thank goodness, and I find my role as Minister with responsibility for education in Northern Ireland challenging and fulfilling.
The point that the hon. Gentleman makes is important. My hon. Friend the Member for Hendon, South (Mr. Marshall) made it clear that we recognise that, even with the loan system, the number of students has increased considerably. That shows that there is an enormous demand for increased higher education within Northern Ireland by the young people of Northern Ireland, and that demand is being satisfied. Since 1988–89, the number of students in higher education institutions in Northern Ireland has risen by 44 per cent. to about 37,500. That is an enormous increase and reflects the value of education in Northern Ireland.

Mr. Ian Bruce: Will my hon. Friend confirm that the Government will continue to operate the loan scheme and will not withdraw loans? Will he also confirm that the Government reject the policy suggestions made by the Labour party in a debate last night—that it would withdraw loans but not introduce any grant in their place? Is not that a strange way in which to increase the number of people in higher education?

Mr. Ancram: I have not seen the report of that debate, but if my hon. Friend is correct, his comments are significant. We are satisfied that the current system, offering a mixture of grant and loan, is effective. It is giving sufficient sustenance to students and that is reflected in the increasing number of young people who wish to enter higher education.

Dr. Hendron: I, too, congratulate the Minister on his new position. Bearing in mind the fact that several thousand students leave Northern Ireland every year to pursue further education in Britain and beyond, will the Minister reaffirm his support for the proposed plan by the university of Ulster for its new university campus, which would stretch between the west and north of Belfast from Springfield road to Woodvale? That proposal commands the support of a massive number of people in both communities and has the support of my colleague and friend the hon. Member for Belfast, North (Mr. Walker) and myself.

Mr. Ancram: Again, I thank the hon. Gentleman for his kind remarks. The Springfield project is still in the early stage of consideration and the university of Ulster is currently carrying out a feasibility study on it. We have made it clear that we would wish to consider the proposal after that study has been carried out, not before. I am sure that the hon. Gentleman will appreciate, however, that we shall have to judge the results of that study within the constraints of available resources.

Mr. Stott: I have already congratulated the Minister in private on his promotion, but I have no objection to doing so formally, once again, for the record.
The Minister said that the number of students entering higher education in Northern Ireland has increased, and the Opposition welcome that. Despite what the hon. Member for Hendon, South (Mr. Marshall) said, the Minister will be aware that recent records show that that number is levelling out, particularly the number of students from poorer backgrounds. They are increasingly deterred from entering higher education because of student loans, which cause them great worry because of the great debts that they cause.
Can the Minister therefore explain how his Department intends to attract students from all backgrounds in Northern Ireland to the proposed fifth campus? Will he tell the House when he intends to meet the Northern Ireland Congress of Trade Unions to discuss the matter, because I gather that, so far, he has refused to do so?

Mr. Ancram: I will meet representatives of the congress when I believe that we have an appropriate agenda for discussion.
I am grateful to the hon. Gentleman for his public congratulations as well as for those which he offered me in private, which I greatly welcomed at the time.
The issue of the number of students from the lower socio-economic groups who enter university education has been raised on a number of occasions. The relevant number for Northern Ireland compares very favourably with that for Great Britain. As I said earlier, of those students who enter higher education in Northern Ireland, 33 per cent. come from the lower socio-economic groups, compared with 21 per cent. in the United Kingdom as a whole. Once again, that suggests that the university and higher education system in Northern Ireland is producing what is required by those who wish to enter it.

High Technology

Mr. Fabricant: To ask the Secretary of State for Northern Ireland what steps his Department is taking to promote investment by high technology manufacturers in Northern Ireland; and if he will make a statement.

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Tim Smith): The Government actively target and encourage inward investment in Northern Ireland by high technology companies and there have been many notable successes in the past year. Companies already located in Northern Ireland are also encouraged to increase their technology base through the provision of assistance for research and development and business expansion.

Mr. Fabricant: I am grateful for that helpful answer. May I take this opportunity of congratulating the Minister on his promotion to the Front Bench? He will be aware that NTL, the privatised arm of the old engineering division of the Independent Broadcasting Authority, is now a world leader in digital audio processing and is developing techniques to provide 16 channels for satellite broadcasting in just one channel space. However, is he aware that Audio Processing Technology from Northern Ireland is providing a vital element to that research? Does he agree that Northern Ireland is now becoming the silicon valley of western Europe?

Mr. Smith: I am grateful to my hon. Friend for his kind personal remarks. He has drawn attention to one high technology manufacturer in Northern Ireland, but I am glad to say that there have been a number of successes recently. Seagate Technology from the United States has announced a 500-job project in Londonderry, Valence Technology from the United States will create 660 jobs in Belfast and Daesung Circuits from Korea will create 120 jobs in Ballymena. That is good news for the Northern Ireland economy and for jobs in Northern Ireland and I am sure that the whole House will welcome it.

Mr. Clifford Forsythe: Without wishing to test the patience of the House, may I congratulate the Minister on behalf of my hon. Friends? He is welcome to Northern Ireland and, although we miss his predecessor, the hon. Member for South Ribble (Mr. Atkins), we wish him every success.
Naturally, we welcome any inward investment into Northern Ireland that the Industrial Development Board manages to bring in. Will the Minister join me in encouraging and appealing to the media to honour the confidentiality of sensitive business projects that may be under negotiation, and to hold their hand until an official announcement is made? Will he continue, as his predecessor did, to consider the interests of firms in Northern Ireland that require financial assistance?

Mr. Smith: I am grateful to the hon. Gentleman and appreciate the warm welcome that I have received in Northern Ireland.
The hon. Gentleman made an important point about confidentiality. It is vital that details of confidential negotiations should not be disclosed prematurely, as that could damage the outcome. I share his view that we should pursue a twin-track approach to investment; indigenous investment in high technology is just as important as inward investment.

Sir James Kilfedder: May I join other hon. Members in congratulating the Minister on his appointment? He will not yet be aware that my constituency of North Down has an unacceptably high level of unemployment, particularly among school leavers and graduates. Will he take effective action to encourage investors to establish high-tech factories in North Down, where great skill and talent are waiting to be tapped?

Mr. Smith: I am grateful to the hon. Gentleman. The Industrial Development Board is keen to attract inward investment to all of the Province, including the hon. Gentleman's constituency. I recognise the importance of what he said about unemployment, although we have recently had the good news that unemployment in Northern Ireland has fallen below 100,000.

Mr. William O'Brien: As the Northern Ireland Industrial Development Board plays a keen part in attracting high-tech industries into the region and must provide infrastructure and factories to encourage people to locate there, what is available to the board to ensure that new high-tech factories can be attracted into the region?
Will the Minister take as read the congratulations from both sides of the House?

Mr. Smith: Considerable resources are available to the Industrial Development Board for attracting high technology manufacturers into the Province, but the Province is in competition with many other regions in the European Community for that highly mobile investment.

Security

Mr. Maginnis: To ask the Secretary of State for Northern Ireland if he will make a statement on the security situation in Northern Ireland.

The Minister of State, Northern Ireland Office (Sir John Wheeler): Inexcusable violence has continued since I answered a similar question on 21 October 1993 and there

have been 34 deaths as a result of the security situation in Northern Ireland. Those include 10 civilians killed in an explosion on the Shankill road, Belfast, the murder of seven civilians at Greysteel, and the murder of 12 other civilians, three police officers and two soldiers.
The Government's first priority is to bring terrorist violence to a permanent end in Northern Ireland. They continue to give their full support to the security forces, who are relentlessly pursuing those responsible for terrorist attacks and bringing them before the courts.

Mr. Maginnis: Does the Minister recognise that, despite the desire for peace in Northern Ireland, the IRA has already, since the end of December, made its decision to reject the Downing street declaration? Will the Minister unequivocally assure us that there is no reduction in the level of the security services' capabilities, including the deployment of special forces? Does he agree that those who promote the interests of Sinn Fein and the IRA in the House are no less traitors than those who laud middle eastern dictators?

Sir John Wheeler: I completely agree with the hon. Gentleman that those who seek to further or encourage violence in any way do the cause of democracy great harm. The Provisional IRA and other terrorist gangs have not ceased their violence since the publication of the joint declaration, despite the unique opportunity offered to them. I deplore the fact that, only this morning, fire bombs were delivered in Limavady and Coleraine, and the cycle of violence and killing has continued unabated. We utterly condemn that course of action. However, I am glad to tell the House that the security forces also have their successes. In 1993, 366 people were charged with terrorist-related offences–60 of them with murder or attempted murder.

Rev. William McCrea: What deal was agreed between London and Dublin in July 1985 concerning the early release of prisoners in the event of the end of violence? Why was not the House informed of that deal and why was it left to a former Prime Minister of the Irish Republic to unveil British Government policy? Surely the policy of the United Kingdom Government should be announced to the people of the United Kingdom at the Dispatch Box by a Minister of Her Majesty's Government. We should not have to rely on someone from Dublin telling us about such a deal.

Sir John Wheeler: I am unaware of any such deal. We live by the rule of law. Those who are sent to prison for offences in Northern Ireland serve their sentences of imprisonment in accordance with the understood procedures and the rule of law. There are no deals.

Political Talks

Mr. Corbyn: To ask the Secretary of State for Northern Ireland if he will make a statement on his recent contact with political parties in Northern Ireland.

Mr. Canavan: To ask the Secretary of State for Northern Ireland if he will make a statement on the recent meetings that have been held with representatives of the political parties in Northern Ireland.

Mr. Ancram: My right hon. Friend the Prime Minister met the four party leaders together on 22 December. All the parties were subsequently invited to continue the private


bilateral discussions that I have been having with the parties since the autumn and these discussions are now in progress.

Mr. Corbyn: Will the Minister assure us that he will continue contacts with all political parties, including Sinn Fein, with which there have been meetings for a considerable period? Will he also assure the House that as the Government are privy to discussions with Sinn Fein, it is time to lift the broadcasting ban on that organisation's leadership and to lift the exclusion order against the president of Sinn Fein, Gerry Adams, so that the possibilities of promoting peace and a ceasefire in Northern Ireland can be further advanced? That would put an end to the 25 years of bloodthirsty conflict.

Mr. Ancram: It is a matter of great regret that today, as earlier this week, the hon. Gentleman has sought to divert attention, and assist Sinn Fein in diverting attention, from the need to renounce violence under the joint declaration and to come to the peace table on that basis. He would be far better served in trying to achieve peace and reconciliation in Northern Ireland if he were to say to his friends in Sinn Fein that they should renounce violence today, enter exploratory talks with the Government and come to the table as a full democratic member of the talks, having renounced violence fully and for ever.

Mr. Canavan: On the clarification of the Downing street declaration, does the Minister accept that there is a big difference between clarification and negotiation or renegotiation? Bearing in mind the fact that the Government are supposed to believe in open government and the fact that parts of the declaration are ambiguous, will the Government respond positively to genuine requests for clarification, even if it means consulting the Irish Government about a joint statement of clarification?

Mr. Ancram: I can only effectively reiterate what my right hon. and learned Friend said. The joint declaration was the result of an enormous amount of careful and long-standing work to produce a document that was self-standing and clear. It would not be in the interests of using that document as a framework for peace now to respond to what purport to be requests for clarification, but which would qualify and renegotiate the document That would not be in the interests of the peace process or of achieving an acceptable political settlement to the problems of Northern Ireland in the longer term.

Mr. Matthew Banks: May I congratulate my hon. Friend on his recent appointment and ask him to make it clear to the House that Britain will not be following the lead of the Irish Government in relaxing the ban on broadcasting on Sinn Fein, unless and until Sinn Fein and the IRA renounce violence or give a clear indication that they intend so to do?

Mr. Ancram: I am grateful to my hon. Friend for his remarks. He will have heard what my right hon. and learned Friend said earlier about the broadcasting ban. If Sinn Fein were to renounce violence permanently, become a constitutional party within Northern Ireland and become part of the democratic process, the implications would have to he considered in that context.

Mr. Molyneaux: As it is abundantly clear that the IRA intends to treat with contempt worldwide appeals for peace, may we assume that the Government will now

proceed, having first taken the necessary steps to extirpate terrorism, to use the words of the Foreign Secretary, to speed up consultations with the constitutional parties, ignoring the sheer nonsense of leaving an empty chair at the table for Sinn Fein to occupy one of these days? In my view, it will be a worm-eaten piece of furniture by the time they arrive there.

Mr. Ancram: I remind the right hon. Gentleman of the remarks that my right hon. and learned Friend made earlier. The talks process is not awaiting anything; it is continuing. My right hon. Friend the Prime Minister made it clear soon after the joint declaration that the talks process would be intensified. It is our intention to move forward with the talks in a more focused way to move the process towards an agreement. I am grateful to the right hon. Gentleman for the fact that his party has been participating fully in those talks and will continue to do so.

Mr. Dickens: Accepting that both Governments support 100 per cent. the Anglo-Irish Agreement, may I ask my hon. Friend to confirm that it is perfectly possible that a new, more broadly based agreement and perhaps a new structure could be considered, but not a moment before Sinn Fein denounces violence and the IRA stop violence?

Mr. Ancram: We have made it clear that if Sinn Fein wishes to be a part of the process that is designed to achieve a political settlement, it must renounce violence to become part of that process. But the process will continue nevertheless. It will continue on the three strands which cover the three sets of relationships within Northern Ireland, between the north and south of Ireland and between the Irish Government and the Government of the United Kingdom. It is the hope of the British Government that those talks will eventually achieve an acceptable settlement that will lead to lasting peace in Northern Ireland.

Mr. McGrady: Will the Minister confirm that the inter-party talks are clearly and unequivocally based on the agreement made by his right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) on 26 September 1991? If there is a three-strand approach to the overall problem, and taking cognisance of the fact that, up to October 1992, the talks indicated the complexity between them—the interweaving between strands one and two—does he intend to engage all six parties, the two Governments and the four democratic parties, in inter-party talks?

Mr. Ancram: On the hon. Gentleman's latter point, I should stress that, at the moment, I am talking to only three parties and that the door is open to that fourth constitutional party in Northern Ireland to join the talks process at any time. I am referring to the Ulster Democratic Unionist party. I assure the hon. Gentleman that the talks that are taking place at the moment are based on the three strands set out on 26 March 1991. That has been the basis of the talks from the time that they were initiated and continues to be so.

Industrial Development, Belfast

Mr. A. Cecil Walker: To ask the Secretary of State for Northern Ireland what further plans he has for the industrial development of north and west Belfast.

Mr. Tim Smith: The Department of Economic Development is setting up an economic working group, comprising its agencies and representatives of local economic development groups, to consider how to encourage more inward investment in north and west Belfast and thus build on recent announcements about new manufacturing projects planning to establish operations in those areas.

Mr. Walker: I, too, congratulate the Minister on his appointment. I trust that he will be able to give the same commitment to Northern Ireland as did his two predecessors.
The Minister's answer reflects the efforts of all those involved in the regeneration of west Belfast, including that of the hon. Member for Belfast, West (Dr. Hendron), which deserves special mention. We need confirmation of what is happening and the Minister's assurance in that respect would be most welcome.

Mr. Smith: I am grateful to the hon. Gentleman and certainly hope to emulate the performance of both my predecessors in my support for investment into Belfast. I pay tribute to the work that he has done in that regard and look forward to working with him.

Trade Unions

Mr. Mackinlay: To ask the Secretary of State for Northern Ireland how often he meets the Irish Congress of Trade Unions and representatives of the major unions representing employees within Northern Ireland to discuss the economy, employment and related issues.

Mr. Tim Smith: My predecessor met leading trade union representatives from time to time to discuss matters of mutual interest and concern. The last meeting was in May 1993. I should like to take this opportunity to congratulate the trade union movement on its pro-active stance for peace and its efforts with employers to keep the workplace free of strife.

Mr. Mackinlay: While echoing the Minister's comments on the trade unions' view and motives with regard to the peace process in Northern Ireland, may I ask him to reflect that ministerial contact with representatives of the trade unions in Northern Ireland is infrequent and insufficient? When it occurs, Ministers do not listen to representations arguing for restoration of the national health service, full rights in terms of employment protection and the capacity to try to persuade the Government against foolhardy processes such as the privatisation of the port of Belfast and the airport. Will he give an undertaking that the Secretary of State and his Ministers will start regular meetings with the trade unions in Northern Ireland so that the views of working people can be adequately represented to the Government of Northern Ireland?

Mr. Smith: The hon. Gentleman may have underestimated the occasions on which Ministers meet trade union representatives. My right hon. and learned Friend the Secretary of State met trade union representatives as recently as November. We have regular contact. I should be very happy to meet them if they so request it.

Mr. Trimble: Were the Government consulted about the guidelines that have just been agreed between the

unions, the employers and the Fair Employment Commission on the display of emblems, not, as hitherto, enabling a minority to object to emblems within the workplace, but now enabling them to object to emblems displayed anywhere within the premises, a significant and sinister shift when one bears in mind the fact that previously FEC officials have tried to intimidate people into not flying the national flag or displaying pictures of Her Majesty the Queen? Were the Government consulted about that and will they take steps to ensure that the FEC does not attempt again to inhibit people from displaying the national flag and the sovereign's face in the workplace or on the premises?

Mr. Smith: I fully understand the hon. Gentleman's concern about this issue. I cannot offer him an immediate answer, so I shall write to him about it.

Anglo-Irish Joint Declaration

Mr. Hunter: To ask the Secretary of State for Northern Ireland if he will make a statement on the representations that he received following the Anglo-Irish joint declaration.

Sir Patrick Mayhew: The significance of the current declaration made on 15 December by my right hon. Friend the Prime Minister and the Taoiseach has been recognised in the reactions to it from around the world. Most of those share the hope that the declaration can and will provide the basis for a lasting peace in Ireland. I welcome the support for the declaration given in the House. In addition, my right hon. Friend and I continue to receive a great number of letters on the subject from members of the public.

Mr. Hunter: In his recent dialogue with interested parties, has my right hon. and learned Friend commented, or been asked to comment, on the view expressed by the Prime Minister of the Republic of Ireland on 10 January that the consent of the majority applies only to the constitutional issue and not to what he called "all other political forms"? Does my right hon. and learned Friend agree with that point of view?

Sir Patrick Mayhew: The agreement speaks for itself. An overall agreement is the objective of the talks process of which the Minister of State, my hon. Friend the Member for Devizes (Mr. Ancram), has spoken this afternoon. The reality is that, to be lasting and durable, new political structures need to secure widespread acceptance and the allegiance of both communities and that is why the talks process seeks agreement across all three strands.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Oppenheim: To ask the Prime Minister if he will list his official engagements for Thursday 20 January.

The Prime Minister (Mr. John Major): This morning, I presided at a meeting of the Cabinet and had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Oppenheim: Will the Prime Minister join me in paying tribute to the courage of British troops who have


fought so bravely for their country, particularly in Iraq? Does my right hon. Friend share the widespread sense of revulsion in the country at the behaviour of the hon. Member for Glasgow, Hillhead (Mr. Galloway) in going to Iraq and saluting the man responsible for perpetrating such unspeakable and appalling atrocities against his own people and also at the actions of other Opposition Members who, by their actions, have given succour to terrorists?

The Prime Minister: I agree with my hon. Friend and I believe that the whole House will think that the hon. Member for Glasgow, Hillhead (Mr. Galloway) was foolish in his action. There is no doubt that Saddam Hussein has inflicted suffering on the Shias and the marsh Arabs, is oppressing the Kurds and denying basic human rights, has victimised British citizens and is failing to comply with United Nations Security Council resolutions. There is, frankly, nothing to be said for him and nothing should be said for him, by any Member of the House.

Mr. John Smith: Does the Prime Minister agree with the Chancellor of the Exchequer that the huge tax increases to be imposed this year and next year will check economic recovery?

The Prime Minister: If the right hon. and learned Gentleman had taken the trouble to listen to my right hon. and learned Friend, he would have heard him say that the recovery is now
strong enough not to be stopped".
I remind the right hon. and learned Gentleman of the facts. The economy has now grown more than 2 per cent. in 12 months and has grown for six successive quarters. Retail sales have grown 4 per cent. in the last year and car production, manufacturing output and export volumes are all up. With low inflation and low interest rates, there is no doubt whatsoever that recovery is under way.

Mr. John Smith: I note that the Prime Minister does not deny that the Chancellor said that the tax increases would check economic recovery. Does not he understand that, as new tax codes arrive in homes all over Britain, people are now seeing the full impact of those increases on their personal standards of living? Why cannot the Prime Minister understand that increases equivalent to '7p on income tax are bound to hit family budgets for six?

The Prime Minister: I reiterate to the right hon. and learned Gentleman that the economy is growing stronger daily. It is growing and it will continue to grow.
Perhaps the right hon. and learned Gentleman could remind the House where tax rates stood when he left office. Investment income was taxed at 98 per cent., top-rate income tax was 83 per cent., corporation tax was 52 per cent. and the basic rate was 33 per cent. The right hon. and learned Gentleman is in no position to talk about taxing, either in the past or today. He complains about the spending reductions made in the public expenditure round. Would he keep those reductions? Would he tax to restore them?

Mr. John Smith: Does the Prime Minister recall saying, during the general election campaign,
Greater taxation would kill recovery stone dead"?
If that was true then, why is not it true now—or is this just one of the many things that the Prime Minister finds it easy to forget ever having mentioned?

The Prime Minister: If the right hon. and learned Gentleman wants to discuss the question of forgetting things, let me point out that he may have forgotten the words of Lord Desai, whom he sacked for telling the truth. Lord Desai said:
It is good for the
Labour
party to have debate about alternatives, competing policy mixes, provided that no one thinks that adopting them or not will make the slightest difference to the actual reality.
The right hon. and learned Gentleman has no economic policy whatever and he cannot hide behind that for ever.

Dame Jill Knight: Does my right hon. Friend agree that it is deplorable for a woman holding the post of headmistress to deny her pupils the chance of seeing one of the greatest English plays ever written by the greatest English playwright, on the ground that it depicts heterosexual love? Will my right hon. Friend join me in deploring that example of political correctness?

The Prime Minister: I think that my hon. Friend has spoken for not only the majority of people in the House, but the majority of people in the country. As for the wider question of politically correct ideology, there is no doubt that it is widely unpopular among parents, who want schools to teach their children the basics of English language, English history and all the subjects that will equip them for a proper adulthood.

Mr. Ashdown: On the subject of listening—[Interruption.]

Madam Speaker: Order. I want some order in the House before we make any further progress.

Mr. Ashdown: rose—[Interruption.]

Madam Speaker: Order. I shall have to start naming Members—[HoN. MEMBERS: "Hear, hear!"]—on both sides of the House. This is an abuse of very precious time.

Mr. Ashdown: On the subject of listening to the Chancellor, did the Prime Minister by any chance hear him say on radio this morning that he did not recognise the difference between spending and investment? Could that be the reason why Britain consistently languishes near the bottom of the class of the 22 advanced countries when it comes to investing in education and our future?

The Prime Minister: The right hon. Gentleman clearly failed to understand what my right hon. and learned Friend had to say this morning. If he examined the text more carefully, he might be able to ask a more credible question on another occasion.

Sir Fergus Montgomery: Does my right hon. Friend accept that, despite the professional whingers, the vast majority of people want to see more deregulation, unnecessary regulation ripped up and bossy bureaucracy banned and that they want unnecessary form-filling for the sake of form-filling to be a thing of the past?

The Prime Minister: My hon. Friend is right, not just for people but also, of course, for business and for many voluntary bodies as well. There is no doubt that the growth of regulation, from the European Community, from this House and from local government, has grown outrageously over the last 25 years and it is necessary to get rid of the regulations. If I had the support of the Opposition in doing that I should be delighted, for we will be introducing a


Deregulation and Contracting Out Bill which will produce the biggest bonfire of unnecessary regulations that the House has ever seen. We will see then which Lobby Labour Members are in.

Mr. Mike O'Brien: To ask the Prime Minister if he will list his official engagements for Thursday 20 January.

The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.

Mr. O'Brien: As parliamentary adviser to the Police Federation, may I ask the Prime Minister whether he is aware of the criticisms of his Police and Magistrates Courts Bill from the police, chief constables and former Home Secretaries such as Lords Whitelaw and Carr, who say that the Bill comes dangerously close to politicising the police? Will he now seek all-party agreement on the Bill and stop introducing things such as the Sheehy report and the Bill which, in the face of rising crime, are undermining police morale?

The Prime Minister: The hon. Gentleman will have to do better than that if he wishes to keep his new job. One of the aims of the reforms is to put a much greater breadth of experience on to police authorities and, as the hon. Gentleman may know, the intention is to bring the experience of many leading members of the community—head teachers, business men, doctors and others—on to police authorities. The police welcome that and they also welcome the increased individual authority given to chief constables, neither of which points was mentioned by the hon. Gentleman.

Mr. Gale: Will my right hon. Friend join me in applauding today's launch of the guaranteed pensioners income bond? Will he accept that the 30 per cent. of my constituents in Thanet, North who are over the retirement age will welcome the Government's recognition of those who have worked hard all their lives, not to be a burden on the state but to be able to provide for their old age themselves?

The Prime Minister: I agree with my hon. Friend. The new bond will be widely welcomed because it will give pensioners a guaranteed return on their savings month in, month out. The other essential element, especially for people on fixed incomes and those who are retired, is to ensure that the value of their savings is not eroded by

inflation. By keeping inflation low, we are helping every pensioner on a fixed income. Not since 1946 has there been such a successful period for inflation as the last 12 months and we intend to keep inflation at a very low level.

Mr. Betts: To ask the Prime Minister if he will list his official engagements for Thursday 20 January.

The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.

Mr. Betts: Does the Prime Minister accept that, in pursuing its disgraceful housing sales policy which disadvantaged so many people in housing need, Westminster council must have annually reported that policy to the Government in its housing investment programme submission? Does he agree that the Government must specifically have approved all the subsidies for the cash incentive scheme under which Westminster emptied its houses and that the Government must also have given a specific consent to the disposal of all properties for which a general consent did not exist under the Housing Act 1985?
Will the Prime Minister therefore give a clear and comprehensive statement to the House of what knowledge his Government had of those policies and what specific approvals his Ministers and his officials gave to that council to enable those policies to be put into practice?

The Prime Minister: The hon. Gentleman clearly is in some dispute with his Front Bench about Labour policy. The hon. Gentleman refers to the disgraceful policy of selling council houses. For much of the past two years, Opposition Front Bench spokesmen have been trying to pretend that they are in favour of selling council houses. [Interuption.]

Madam Speaker: Order. The Prime Minister must be heard. [Interruption.] Order. I shall not proceed until there is some order in the House.

The Prime Minister: As I was saying a moment ago, the hon. Gentleman had better be clear about whether his party is in favour of selling council houses or not, for there is a great difference between what he said and what spokesmen on the Front Bench have been saying. The reality is that hundreds of thousands of people in the country are home owners today because we gave them the freedom to be so, and that policy is undoubtedly correct.

Business of the House

Mrs. Margaret Beckett: Will the Leader of the House state the business for next week?

The Lord President of the Council and Leader of the House of Commons (Mr. Tony Newton): Yes, Madam. The business for next week will be as follows:

MONDAY 24 JANUARY—Second Reading of the Social Security (Incapacity for Work) Bill.
TUESDAY 25 JANUARY—Second Reading of the Finance Bill.
WEDNESDAY 26 JANUARY—Opposition Day (second allotted day). There will be a debate on housing on an Opposition motion.
THURSDAY 27 JANUARY—There will be a debate on the Royal Air Force on a motion for the Adjournment of the House.
FRIDAY 28 JANuARY—Private Members' Bills.
MONDAY 31 JANUARY—Consideration in Committee of the Finance Bill.

Madam Speaker, the House will also wish to know that European Standing Committee 'B' will meet on Wednesday 26 January at 10.30 am to consider unnumbered explanatory memoranda from the Department of Employment relating to parental and family leave and to part-time and temporary work.

[Wednesday 26 January:

European Standing Committee B
European Community Documents

a) Unnumbered Parental and family leave
b) Unnumbered Part-time and temporary work
Relevant European Legislation Committee Reports
a) HC 79–xxxvii ( 1992–93) and HC 48–ii (1993–94)
b) HC 79–xxxviii (1992–93) HC 48–i (1993–94) HC 48-iv (1993–94)]

Mrs. Beckett: May I press the Leader of the House again to find Government time for a full debate on the Child Support Agency? Opposition Members recognise that there will at some stage be an opportunity for debate on the orders that the Government have tabled, but I hope that the Leader of the House recognises that Members on both sides of the House will feel that an hour and a half, very probably, as it means embarrassment for the Government after 10 o'clock, will not be sufficient to explore the many concerns about the matter, especially as such a debate would be only on orders that could not be amended. I therefore press him to find time for a general debate on the matter in advance of the specific orders.
Secondly, can the Leader of the House find time for a debate about the waste of public money? I think that he will recognise that examples of waste, such as the spending of £500 million as a result of the Government's mismanagement of the process of introducing the national curriculum when funds for school building are being cut, are again causing great concern on both sides of the House. We would like the opportunity to explore that in Government time.
Thirdly, will the Leader of the House give serious consideration to increasing the amount of time that is available to the Opposition for debates? As the only debates that we have had about housing or health since the

general election have been in Opposition time, obviously it is necessary to increase the time if we are to debate the wide range of issues that concern the country.

Mr. Newton: The Government have provided the House with ample opportunity to debate a wide range of important issues, but the most appropriate comment that I can make, both on the right hon. Lady's first question and on her last, is that it would be a good deal easier to know how best to please her if we could have sensible discussions in the usual channels. The sooner she returns to that the better.
As for the suggestion about the waste of public money, I am quite tempted by that thought, as most of the expertise in the world rests on the Opposition Benches.

Mr. Tim Devlin: May we have an early debate on today's report by the Northern Development Company, which says that home sales and export sales are both up, profits have risen, home orders have recovered, export orders have bounced back, and plant and machinery investment has improved? I am sure that many Conservative Members would like to tell the Opposition about all that.

Mr. Newton: I do not know whether all that would be in order on Second Reading of the Finance Bill, but with ingenuity it might possibly be. However, my hon. Friend would find it difficult to make a better speech more crisply than the one that he has just made.

Mr. Paul Tyler: May I remind the Leader of the House that our usual channels are still open? Does he recall that he gave the House an assurance more than a month ago, before the Christmas recess, that he would seek time for a debate on early-day motion 134, which refers to the hill livestock compensatory allowances.

[That an humble Address be presented to Her Majesty, praying that the Hill Livestock (Compensatory Allowances) (Amendment) (No. 2) Regulations 1993 (S.I., 1993, No. 2924), dated 29th November 1993, a copy of which was laid before this House on 30th November, be annulled.]

Is the right hon. Gentleman aware that since then the Minister of Agriculture, Fisheries and Food has issued a press release giving full details of the scheme, before it has come before the House? Does he agree that that is yet another example of government by press release, which is due to contempt for the House?

Mr. Newton: I shall, of course, continue to bear the hon. Gentleman's request in mind, especially in view of what he has said about it being easier at present to do business with him than with the right hon. Member for Derby, South (Mrs. Beckett).

Sir Peter Emery: Will my right hon. Friend consider introducing next week certain recommendations made by the Procedure Committee since 1984—a process that culminated in the Jopling report—[HON. MEMBERS: "Hear, hear"]—covering the immediate reference to Committee of all affirmative statutory instruments, voting on Ways and Means and money resolutions without debate after a Second Reading, restricting statutory instrument debates started before 10 o'clock to 90 minutes, and—this is perhaps as important as anything—the automatic programming of Bills in Committee so that we can get them through sensibly and properly debated?

Mr. Newton: The reception of my right hon. Friend's remarks by my right hon. and hon. Friends may bring home to others in the House the fact that some of the disruption that the Opposition are seeking to bring about, even if it is aimed at the Government, is actually aimed at, and is beginning to affect, the effective working of Parliament. The Opposition should think about that.

Several hon. Members: rose—

Madam Speaker: Order. I now make a plea for brisk questions and brisk answers, please. I hope that it does not fall on deaf ears.

Mrs. Margaret Ewing: As the Leader of the House clearly understands the importance attached in Scotland to our distinctive legal system, will there be an early opportunity to consider how the House deals with separate Scottish legislation, given the fact that we are apparently not allowed to debate the orders pertaining to costs in sheriff courts for civil actions, and that much of the Scottish legal process is being tagged on to Bills with United Kingdom implications, and we are not fully represented on the Committees on such Bills?

Mr. Newton: The hon. Lady will know that my right hon. Friend the Secretary of State for Scotland has been considering various matters, and I am sure that he will consider her requests, along with many others.

Mr. William Powell: Will my right hon. Friend make time available to debate early-day motion 358, dealing with the explosion in organised professional crime involving heavy goods vehicles, trailers and cargoes?

[That this House is alarmed at the ever increasing number of thefts of and from heavy goods vehicles and other commercial vehicles and trailers and from associated warehouses; notes the consequential increases to insurance premiums which are now being charged to hauliers in order to meet the cost of such criminal enterprises; is appalled at the general damage to commerce which results and deplores the reduction in the number of police officers and the Metropolitan Police Serious Stolen Motor Vehicles Investigation Squad, SO I (6); and calls for a national campaign to be co-ordinated by the Home Office and to involve all police forces as well as representatives from insurance companies and the road haulage industry in order to defeat this most serious explosion of organised, international crime.]

That epidemic is taking on the most serious proportions for the commerce of our country.

Mr. Newton: The importance that the Government attach to reducing and fighting crime was made clear in the Bill which was debated last week. I have no doubt that further proceedings on that Bill will give my hon. Friend an opportunity to expand on what he has said.

Mr. D. N. Campbell-Savours: Has the Leader of the House been approached by the hon. Member for Rutland and Melton (Mr. Duncan) asking to be given the right to make a personal statement telling the House——

Madam Speaker: Order. Personal statements have nothing whatever to do with the Leader of the House. They

are my responsibility. If the hon. Member for Workington has a question for the Leader of the House, I shall be prepared to hear it.

Mr. Campbell-Savours: —asking whether an opportunity might be given to the hon. Gentleman to tell the House that he may be intending to repay to Westminster council ratepayers the £50,000— —

Mr. David Shaw: Did you tell him?

Mr. Campbell-Savours: Yes. I am talking about the £50,000 profit that the hon. Member for Rutland and Melton made by buying the council house next door at a discount. I tell the Leader of the House that I intend to keep raising this issue because I believe that it is fundamentally important.

Mr. Newton: My hon. Friend has clearly explained what occurred. I do not propose to add to what I said when I last answered on behalf of my right hon. Friend the Prime Minister.

Mr. Richard Alexander: May I press my right hon. Friend for a debate on the Child Support Agency? Has he not had representations from his constituents, as I have, that the formula for assessing income does not leave a person enough money to deal with present commitments? Unless we are to have a resentful underclass in the country, should not we fully debate the operation of the agency, because there is great resentment among all sections of the community?

Mr. Newton: My hon. Friend is of course right. Like other right hon. and hon. Members, I have had representations that I have passed on to my right hon. and hon. Friends. He will be aware of their responses to those representations which have led to regulations, which, as the right hon. Member for Derby, South (Mrs. Beckett) said, we shall be debating relatively soon.

Mr. John Spellar: Following on from the question about government by press release, will the Leader of the House arrange for statements to be made when press releases are issued during the holidays? Will he especially ask the Secretary of State for Employment to make a statement on public holidays and the possible replacement of May day, and tell us why Trafalgar day has been ruled out? Some of us suspect that Lord Nelson failed to meet the criteria of "back to basics".

Mr. Newton: At least I can reject the hon. Gentleman's ingenious explanation. As for the rest of his question, I shall bring it to the attention of my right hon. Friend the Secretary of State for Employment.

Mr. John Denham: Is the Leader of the House aware that the past week has been extremely bad for industrial jobs in the Southampton area, with 200 job losses at Aerostructures at Hamble and 200 job losses at British Rail Maintenance Ltd, which both employ many of my constituents? May I remind the right hon. Gentleman of the repeated requests from Members on both sides of the House for a debate on the future of the aerospace industry, which is at the heart of our manufacturing base and which has suffered more than 100,000 job losses in recent years? In pressing for that debate— —

Madam Speaker: Order. I have asked for brisk questions as many hon. Members wish to ask questions. We shall by no means cover all of those who want to speak if we have long statements. A brisk question is required.

Mr. Denham: I wish to raise the plight of the rail industry as well—both industries are in a serious state—but I think that I have made my point.

Madam Speaker: Well done. I am sure that you have.

Mr. Newton: That is a better answer, Madam Speaker, than any that I can give.

Mr. Bob Dunn: Is it possible to have an early debate on the senior appointments which have been made by left-wing Labour councils in the light of the announcement yesterday of the hon. Member for Bolsover (Mr. Skinner) that at least one senior education officer was appointed to his post because he was a member of the Labour party?

Mr. Newton: As with the request of the right hon. Member for Derby, South (Mrs. Beckett) for a debate on waste, I am sympathetic to my hon. Friend's request.

Mr. Patrick Thompson: Bearing in mind the fact that concern has already been expressed about the best use of parliamentary time, will my right hon. Friend support all those in the House, including my right hon. Friend the Member for Honiton (Sir P. Emery), who wish to have an early debate on the Jopling report? The time has come to debate that vital issue.

Mr. Newton: That, too, is a request which I will bear in mind.

Mr. Lawrence Cunliffe: I refer to early-day motion 387.

[That this House is concerned that if the European Commission accept the standard Euro two pin plug as proposed by CENELEC as part of the European plug and socket harmonisation programme the result would be that of scrapping the safest domestic power system in Europe; notes that the cost of such a change is estimated at £20 billion or £1,000 per household and that United Kingdom manufacturers are faced with massive re-tooling and plant replacement costs compared with our competitors on the European mainland and a large proportion of 20,000 United Kingdom citizens would be put at risk; and calls upon Her Majesty's Government to reject the proposals.]

Will the Leader of the House arrange for an early debate on the European Commission's attempt to impose on Britain a domestic plug, called the Europlug, for use in an electrical system that will cost about £20 billion in conversion costs? Its use will endanger practically all the 20,000 jobs in the related industries and will destroy what is fundamentally the best and most safe domestic electrical system of lighting in Europe. Does the Leader of the House agree that, time and again, whacky bureaucrats in Brussels attempt to impose totally unacceptable conditions which pose a great risk to jobs and safety?

Mr. Newton: There is no such standard at the moment, of course. If one were to emerge, we would have to decide whether to seek a derogation, and I am sure that the hon. Gentleman's points would be kept in mind.

Mr. Nicholas Budgen: Will my right hon. Friend undertake that, on Friday next

week, the Government will not block the Bank of England (Amendment) Bill? Does he agree that, if the Government did so, it would be widely resented in the House as an attempt to prevent a useful small measure that would give parliamentary accountability for monetary policy, and that it would be even more widely misunderstood by those who will be asked to lend the Government £1 billion every week?

Mr. Newton: I will draw my hon. Friend's remarks to the attention of my right hon. Friend the Chief Whip. Of course, it is the fate of the Government that they are often misunderstood.

Mr. Dennis Skinner: Will the Leader of the House ask the President of the Board of Trade and the Attorney-General to make statements on the intriguing affair regarding Venables and his companies? Will the right hon. Gentleman give an assurance that the Government will not ask the Serious Fraud Office to get rid of some of the charges that it is investigating and that the Department of Trade and Industry will not drop the serious charges against another Venables company, because Alan Sugar, the Tory business man, is trying to concoct a deal in which he backs Venables, provided that the dogs are called off in the inquiry into Tottenham? There has been a lot of sleaze in Britain of late, surely— —

Madam Speaker: Order.

Mr. Newton: The hon. Gentleman knows perfectly well that I could not possibly begin to comment on such a matter. In my view, that is not the way in which the hon. Gentleman should use the Chamber.

Mr. Tony Marlow: Will my right hon. Friend say whether the amendment to the Criminal Justice and Public Order Bill which was tabled by my hon. Friend the Member for Derbyshire, South (Mrs. Currie) will be debated on a free vote on the Floor of the House? If it is, may we also have a debate on a free vote, as I asked my right hon. Friend last week, on an amendment tabled by more than 30 colleagues on the subject of corporal punishment for young offenders as an alternative to imprisonment? I am sure that most of my right hon. Friend's constituents and my constituents would regard that amendment as being more in tune with "back to basics" than the previous amendment.

Mr. Newton: I cannot add to what I said to my hon. Friend last week.

Mr. George Foulkes (Carrick, Cumnock and Dom Valley): Is the Leader of the House aware that the First Scottish Standing Committee will not meet next week because the Government are trying to gerrymander that Committee in the same way as they are gerrymandering local government in Scotland? Will he think again about that matter? The arithmetic favours the Opposition's case, which is supported by the Liberal Democrats. Such arrogance by the Government has caused the breakdown in the usual channels.

Mr. Newton: That is a matter for the Committee of Selection.

Sir Nicholas Fairbairn: Will my right hon. Friend arrange an urgent debate on proposed changes to the charging of fees in sheriff courts in


Scotland? Civil litigants will have to pay for judges' salaries and many people will be prevented from litigating their just rights.

Mr. Newton: I do not think that I can promise a debate on that matter. Of course, my right hon. Friend the Secretary of State for Scotland will be present at Question Time on Wednesday.

Mr. Max Madden: Will the Leader of the House undertake to arrange a debate in Government time on a Government motion before Her Majesty's Government give formal or informal support to any withdrawal of United Nations forces, including British forces, from Bosnia?

Mr. Newton: I am sure that there will be further opportunities for debate on Bosnia, whatever the circumstances. I will bear the hon. Gentleman's point in mind.

Mr. Spencer Batiste: My right hon. Friend will be aware of the current public consultation process in regard to opencast mining and its effect on the environment, under the review of mineral planning guidance 3. That matter is particularly important with respect to the coal privatisation Bill. Can my right hon. Friend give an assurance that there will be an opportunity to debate that subject, which is of great importance to many constituencies?

Mr. Newton: My hon. Friend will be aware that the Coal Industry Bill is currently before the House, which will give many opportunities to raise such matters.

Mr. Bob Cryer: May we have a debate next week on GATT? Is the Leader of the House aware that some leaders of the textile industry are saying in private that the Government negotiations have sold the industry down the river? I have 11,000 textile workers in my constituency in the city of Bradford. It is an important industry. Tariffs work very much against the industry. In India, for example, they are set at 100 per cent. and in Turkey at 21 per cent. We need clarification of the Government's negotiations.

Mr. Newton: The Government intend to present to the House a White Paper on the results of the GATT round later this year. That will be the appropriate time to consider the possibility of a debate.

Mrs. Angela Knight: Will my right hon. Friend consider initiating an early debate on councillors' allowances? Is he aware that the former deputy leader of Derbyshire county council has been gaoled for defrauding the council on his expenses and is currently serving his sentence in prison, yet is still receiving his council allowances? Does not my right hon. Friend consider that to be a shocking state of affairs and that it should be prevented?

Mr. Newton: I have seen those reports. I am not sure whether the hon. Member for Bolsover (Mr. Skinner) has seen fit to coment on them or, indeed, whether the district auditor is involved. My hon. Friend may wish to consider that.

Dr. Joe Hendron: Will the Leader of the House make time available soon for a debate on extradition, bearing in mind that any citizen of this country can be sent to anywhere in the Community by a court without at any time having been questioned by the police?

Mr. Newton: I shall bring that point to the attention of my right hon. Friends who have responsibility for such matters.

Mr. John Wilkinson (Ruislip-Northwood): In the absence of a much-needed debate on foreign affairs, will my right hon. Friend ask our right hon. Friend the Foreign Secretary to make a statement on the Government's attitude to the situation in the Balkans, and in Bosnia in particular, when he returns from Turkey and Bosnia next week?

Mr. Newton: I shall bring that request to the attention of my right hon. Friend on his return. I note the introduction to my hon. Friend's question, but I point out to him that he will have the opportunity to speak in the debate on the Royal Air Force next week.

Mr. Bill Olner: Will the Leader of the House reconsider holding a debate on the Child Support Agency, which is causing tremendous difficulty, pain and hardship to many constituents of hon. Members on both sides of the House? I urge him to allow a full discussion on the matter.

Mr. Newton: I note the hon. Gentleman's request, but I cannot add to what I said on the subject on a couple of earlier occasions.

Mr. Richard Spring: Will my right hon. Friend urgently consider having an early debate on Iraq and its leader, the dictator Saddam Hussein, so that public opinion can be satisfied that there is very little support for the scandalous views of the hon. Member for Glasgow, Hillhead (Mr. Galloway)?

Mr. Newton: My hon. Friend perhaps understates his case. We do not need a debate to know that there is no support whatever for the sentiments that are said to have been expressed.

Dr. Tony Wright: Has the Leader of the House had a chance to read early-day motion 389 on double summer time?

[That this House recognises the enormous advantages for all the people of this country in moving Britain's clocks forward by one hour throughout the year, thereby matching daylight and waking hours more effectively; notes that the move is supported by the Royal Society for the Prevention of accidents and the Police Federation because, according to Transport Research Laboratory calculations, the result of such a move would be 140 fewer fatalities and 520 fewer serious injuries on the roads every year, with the Scots benefiting proportionately more than others; further notes that an extra hour of evening daylight would benefit children, working women, and elderly people, who are disadvantaged and threatened by the early dusk and darkness, as well as cutting energy costs by £260 million per year; recognises the benefits that extra evening light would have on the health and life style of the British people, and the £1 billion increase in tourism revenues that the consequently longer holiday season would provide; similarly recognises the greater convenience to all business people


communicating with and travelling to and from Europe; welcomes the European Commission's review of summer time arrangements in the Community which has now resulted in the adoption of a Directive to ensure that all EU members end summer time along with Britain in October; and therefore calls on the Government to allow Parliament to decide on Britain's move to single/double summer time at the earliest opportunity.]

Does he accept that it is time that the House came to a view on that matter, that the issue has dragged on for long enough, that the motion has widespread support throughout the House and the country and that it is time for the Government to bring a little extra daylight into people's lives?

Mr. Newton: The hon. Gentleman will know that, while there is support for the early-day motion, a number of people have expressed serious reservations about it. A balance has to be struck and the Government are considering that.

Mr. Barry Field: My right hon. Friend kindly wrote to me and said that the order giving effect to a unitary authority on the Isle of Wight would be laid before the House. Will he reassure me and all other hon. Members that the delay that has occurred so far has not been occasioned by the Liberal Democrats' activists handbook, which is full of racist comments about minority dialects such as that of my hon. Friend the Member for Winchester (Mr. Malone), who has taken considerable offence? Will my right hon. Friend reassure me that the order will be laid before the House before long?

Mr. Newton: I can certainly assure my hon. Friend that there is no connection between the two points that he raised. I shall communicate with him further about the timing of the debate.

Rev. Martin Smyth: The Leader of the House will have seen that the draft Ports (Northern Ireland) Order was laid yesterday. Will he consult the Secretary of State through the usual channels with the idea of having a grand Committee examine it, or possibly having a debate on the Floor of the House with extended time, bearing in mind the importance of the order to the whole Northern Ireland economy?

Mr. Newton: As to the usual channels, I am grateful for the indication that the hon. Gentleman is ready to talk to us about the handling of these matters. I am sure that my right hon. and learned Friend the Secretary of State for Northern Ireland will discuss the matter with him in the spirit in which he raised it.
I should make it clear to my hon. Friend the Member for Isle of Wight (Mr. Field) that, when I referred to a debate, I should have referred to the laying of the order.

Mr. Patrick Nicholls: Can my right hon. Friend find time for a debate on early-day motion 341?

[That this House calls upon the Right honourable Member for Yeovil to disassociate himself from the description by Tom Dommett, a Liberal Democrat County Councillor, of his constituents in Somerset, as 'Yids, Nig-nogs, !ties and Pakis … no better than New Age scum and vermin'; believes that the use of such grossly offensive language about people of other nationalities and races is wholly unacceptable in public life; notes that this is yet the latest example of blatant racism within the Liberal

Democrat Party; and calls upon the Leader of the Liberal Democrat Party, the Right honourable Member for Yeovil, to expel Councillor Dommett from the party forthwith.1

It refers to the remark by a Liberal councillor in Somerset that his constituents were no better than "Yids, Nig-nogs, Ities and Pakis". Would not a debate give the leader of the Liberal party an opportunity to explain to the House how he can stomach having someone like that in his

Mr. David Bendel: rose—

Mr. Newton: Perhaps the hon. Gentleman is about to give us an explanation.

Mr. Peter Hardy: I draw the attention of the Leader of the House once again to the deep anxieties about the engineering steel industry. May we have time in the House for the Government to make it clear and give an assurance that the British engineering steel industry will not be taken out by unfair competition from heavy subsidies paid in the EC?

Mr. Newton: The hon. Gentleman is right to remind us that he has raised this issue before, but I cannot add to what I said on the previous occasion.

Mr. Anthony Coombs: Given the much-vaunted European political organisation, especially the extradition agreement within Europe, may we have a debate on foreign affairs to discuss the recent appalling action of the French Prime Minister in refusing to extradite to Switzerland two Iranian nationals who are wanted there on murder charges? Could we explain to the French Prime Minister that a consistent application of extradition should depend on issues of justice and not merely on French commercial interests?

Mr. Newton: I shall bring my hon. Friend's remarks to the attention of my right hon. Friend the Foreign Secretary.

Mr. John Austin-Walker: Is the Leader of the House aware that domestic violence accounts for 25 per cent. of all reported violent crime? I draw his attention to early-day motions 357 and 383.

[That this House congratulates the Association of London Authorities on its Zero Tolerance Campaign, London's first major crime prevention campaign on the issue of violence against women; notes that a local London survey found a third of women questioned had experienced domestic violence and nearly two-thirds of men said they would be violent towards their partner in certain circumstances; further notes that domestic violence accounts for a quarter of all reported violent crime; calls for active prevention of crimes of violence against women and children, adequate provision of support services for women and children and appropriate legal protection for women and children who are victims of violence; and calls on the Government to implement in full the recommendations of the Home Affairs Select Committee report on Domestic Violence.]

That this House congratulates Edinburgh District Council on the launch of the second phase of its Zero Tolerance Campaign, an initiative which is now being replicated throughout Britain; notes that Tayside and Strathclyde Regional Council, Aberdeen District Council and the Association of London Authorities have been at the forefront of supporting Edinburgh's initiative; and calls upon the Government to ensure a fair and reasonable amount of funding for women's aid and rape crisis groups.

They highlight the excellent work being carried out by the Association of London Authorities and Edinburgh city council in crime prevention. Will the Leader of the House find time for a debate on domestic violence so that we can discuss the full implementation of the recommendations of the Home Affairs Select Committee?

Mr. Newton: The Government agree that it is important to raise public awareness of this problem, and are currently considering what more can be done in this respect.

Mr. Harry Greenway: May I ask my right hon. Friend for a debate next week on the speed and flow of traffic in London—especially in west London and, within that area, in Northolt at the Target and White Hart roundabouts where phased traffic lights are urgently needed—so that the House can press Ealing council to introduce traffic lights which are urgently required?

Mr. Newton: My right hon. Friend the Secretary of State for Transport is due here to answer questions next Monday. As I have done on one or two previous occasions, perhaps I shall give him advance warning of a point that might be raised.

Mr. Roy Hughes: I remind the Leader of the House that on 29 October 1993 the Government, by the back-door method of a written answer, announced the termination of the readaptation benefits scheme for the steel industry. Meanwhile, the industry is being plagued by subsidised foreign competition. When will we have a debate on this vital industry?

Mr. Newton: The hon. Gentleman understandably raises the same point that was raised two or three questions ago. I cannot add to what I said on that occasion.

Dr. Robert Spink: Will my right hon. Friend find time for a debate on "BB—not "back to basics", but the evil of badger baiting? Anyone who saw the television programme on the subject earlier this week will know how sickening that practice is, and will know that the perpetrators must be brought to justice.

Mr. Newton: It is just possible that my hon. Friend will get an opportunity to raise that matter next week, when my

right hon. Friend the Minister of Agriculture, Fisheries and Food will be answering quetions. In any event, I will bring my hon. Friend's remarks to her attention.

Mr. Elfyn Llwyd: In the light of the soaring crime rate in north Wales and the continued refusal of the Home Office to allow an addition to the complement figure of that area's police force, when may we reasonably expect a debate on that important subject so that the people of north Wales are given the services of an adequate police force? With the best will in the world, they cannot do the job without resources.

Mr. Newton: I note the hon. Gentleman's point, but I cannot promise an early debate on that specific matter.

Mr. Stephen Milligan: May we have an early debate on investment in safety in the railway industry in the light of the announcement yesterday of nearly 200 redundancies in my constituency in the railway maintenance yards? Is my right hon. Friend aware that technology has been developed at Eastleigh for secondary door locks? Those locks could not only save the many lives which are lost through passengers falling out of moving trains, but could also secure many hundreds of jobs in the railway works at Eastleigh.

Mr. Newton: I will mention that point to my right hon. Friend the Secretary of State for Transport, and my hon. Friend may care to do the same on Monday.

Mr. David Winnick: Will the Foreign Secretary make a statement about what representations, if any, have been made to the German authorities about the massacre of British troops who were taken prisoner at Dunkirk in 1940 and about the role of the notorious and fanantical Nazi, Mohnke? If we are concerned, as we should be, about present-day butchers such as the man who presently rules Iraq, should not we be equally concerned about the butchers responsible for the massacre of our troops? Should we forget about it just because it happened 54 years ago?

Mr. Newton: Certainly not the latter. The hon. Gentleman will know that the jurisdiction in that case lies with the German authorities and that the British authorities have given full and active co-operation to the German authorities in the investigation.

Points of Order

Mr. Richard Burden: On a point of order, Madam Speaker. On the Order Paper yesterday there was a question from myself to the Secretary of State for Employment. I asked a straight and factual question about whether a firm called Coltman Precast had notified his Department of impending redundancies, and what the date of that notification was. The answer I received from the Minister was that the information required under those provisions was given in confidence.
Is it in order for a Minister to refuse to answer a direct question from an hon. Member when the law says nothing about confidentiality? Is that an example of Ministers attempting to aid and abet employers who seek to evade their statutory responsibilities?

Madam Speaker: First, I thank the hon. Gentleman for giving me notice of his point of order. I am sure that he appreciates that Ministers are solely responsible for their answers to parliamentary questions. It is entirely a matter for the Minister in question, and is not a matter for the Chair. However, I want to be helpful to the hon. Gentleman who might seek parliamentary opportunities to pursue the matter. Although I do not give guidance across the Floor of the House, he may like to come and see me. If he wishes to reflect on the matter, he may well know how to raise it in some other appropriate way.

Mr. Simon Burns: On a point of order, Madam Speaker. I understand that you cannot discuss security matters, but I seek guidance about whether it is in

order for hon. Members, and in particular the hon. Member for Islington, North (Mr. Corbyn), to invite and bring in to this building members of Sinn Fein? Given that the Government are still awaiting the renunciation of violence from the IRA, surely people who will not renounce violence should not be invited into this building.

Madam Speaker: I am, of course, not prepared to discuss security matters, but what took place was perfectly in order providing that the room was booked in accordance with the relevant regulations, as I understand was the case in this instance. I dealt with the matter earlier this week. Had the meeting not been in order, I would of course not have allowed the use of the room.

BALLOT FOR NOTICES OF MOTION FOR MONDAY 7 FEBRUARY

Members successful in the ballot were:
Mr. John McAllion
Mr. Robert Ainsworth
Mr. David Alton

BILL PRESENTED

NORTHERN IRELAND TERMINATION OF JURISDICTION

Mr. Tony Benn, supported by Mr. Jeremy Corbyn, Ms Diane Abbott, Mr. Harry Cohen, Mr. Bob Cryer, Mr. Bill Etherington, Ms Mildred Gordon, Mr. Bernie Grant, Mr. Ken Livingstone, Mr. Bill Michie, Mr. Dennis Skinner and Mr. Alan Simpson, presented a Bill to terminate British jurisdiction in Northern Ireland, and for purposes connected therewith: And the same was read the First time; and ordered to be read a Second time upon Friday 20 May and to be printed. [Bill 36.]

Opposition Day

[1ST ALLOTTED DAY]

National Health Service

Madam Speaker: I must inform the House that I have selected the amendment in the name of the Prime Minister. Because of hon. Members' great interest in the debate, I have had to limit speeches between 7 pm and 9 pm to 10 minutes. I make the strongest plea to those who speak outside those hours to limit their speeches voluntarily so that I may call as many hon. Members as possible.

Mr. David Blunkett: I beg to move,
That this House deplores the lack of accountability, the growth in bureaucracy and waste of resources which have occurred at the expense of patient care arising from the implementation of the National Health Service and Community Care Act 1990.
Before I begin my speech, may I appeal to the Secretary of State to make Government time available for an open and non-party debate in the House about infertility and embryology research. During the Christmas recess, great concern was expressed about that issue and the House should have the opportunity to debate it in Government time.
I mention Government time because it is two and a half years—it was 1991—since the Government last came to the House, voluntarily, to debate the national health service. It is exactly a year to the week since we had a debate on the NHS and, just like today, it was held in time allocated to the Labour party. That was not surprising, because the Government have a great deal to answer for.
The Government have created chaos in the greatest health service in the world; they have undermined the confidence of those who work in the service at every level; they have created a situation where instead of money being spent on patient care, it is spent towards servicing the system; they have created a situation in which 100,000 more people are on waiting lists than at the time of the general election. In the first half of this financial year, there was a jump of 25 per cent. in those waiting for more than a year. Last year, there was an increase of 37 per cent. in the number of complaints made.
The Government have deliberately created two-tier access to services with the creation and encouragement of general practitioner fundholding. Their record is a disgrace. In the past year, one in five accident and emergency units were closed. Since the Government came to office, one third of all beds have been lost and one quarter of all hospitals have been closed. That has happened without commensurate investment in care in the community and localised community care facilities. That is a sorry record, but the Government try to blame it on those who work in the health service.
The Secretary of State for Wales said that it was all the fault of the men in the grey suits. It is not their fault, but the fault of the Secretary of State for Health. She is responsible for what has happened to the health service and its work force. We are defending, promoting and encouraging the NHS as we know it—and we created it.
We are fighting against corruption, commercialisation, privatisation, waste and the politicisation of the service at every level.
We must do that because the Government, during 15 years in office, have forgotten the definition of the proper conduct of public business. From Westminster and Wandsworth borough councils to the hon. Members for Rutland and Melton (Mr. Duncan) and for City of Chester (Mr. Brandreth), to quangos and trusts up and down the country, every inch of public life is being packed by the Conservative party supporters.

Mr. Michael Bates: Does the hon. Gentleman include in the trusts that he accuses of being packed with Conservative party supporters the new chairman of the Priority Health Care Wearside trust, Mr. Joe Mills, former chairman of the regional Labour party in north-east England?

Mr. Blunkett: The exception proves the rule. A recent survey showed that 70 per cent. of those prepared to declare a political conviction were Conservatives. Figures placed in the Library by the Government on Tuesday reveal that 60 per cent. of all chairs of trusts in England have a business or financial background; 50 per cent. of non-executive members have a business or financial background; and only 4 and 6 per cent. respectively have any connection whatever with the national health service.

The Secretary of State for Health (Mrs. Virginia Bottomley): Does the hon. Gentleman also include Helene Hayman, chairman of the Whittington trust? Does he include his own spokesman in the House of Lords, Baroness Jay, who is a member of the health authority?

Mr. Blunkett: Yes, I include them in the 4 per cent. who have an interest in the health service.
I draw attention to the position in south Wales, Scarborough, Glasgow and Gravesham. Let us take a little look at Gravesham. The five non-executive members of the Dartford and Gravesham trust were announced just a few weeks ago: Professor Kelly is a neutral; Kenneth Shaw, a banker, is a Tory councillor; Malcolm Nothard, who is in insurance, is a Tory councillor; Eileen Tuff is a chair of the local Tory association; and Janet Dunn happens to be the wife of the local Tory MP.
May I mention the names of a few other spouses? Mr. T. Shephard of King's Lynn; Mrs. S. Taylor of Southend; Mrs. S. Biffen of Shropshire; and Mrs. Gardiner of Surrey ambulance service—who are they married to? [Interruption.] The hon. Member for Lancaster (Dame E. Kellett-Bowman) shouted,"Sexist.." [HON. MEMBERS: "She is not here."] There is nothing sexist about mentioning both sexes.

Several hon. Members: rose—

Mr. Blunkett: I shall give way in a moment.
What about ex-Members of the House, from before the last election? Mr. T. Flavell, Lord Jenkins, Lord Hayhoe and Sir Timothy Raison were all appointed to trusts. Trusts are a bit like Woody Allen films. We start out with husbands and wives and end up seeing crimes and misdemeanours.

Mr. Jon Owen Jones: My hon. Friend neglected mentioning the former Member for my constituency, Mr. Ian Grist, who lost his seat at the last election. He is now chairman of the health authority in


South Glamorgan and today he announced the closure of the acute unit of the district hospital in my constituency—formerly his constituency. He should have been here to protect it and was then appointed chairman of the health authority to close it.

Mr. Blunkett: I am sorry that I must miss certain former Members, spouses or Tory party Members, because the service is riddled with them. Other hon. Members will no doubt make similar points.

Mr. Andrew Rowe (Mid-Kent): I should be sorry if the hon. Gentleman omitted to mention my wife. His comments raise an interesting question in relation to Labour party policy. Is the hon. Gentleman saying that a woman who has worked for more than 20 years in the national health service and allied jobs, and who, long before she married a Member of Parliament, had built up a considerable reputation for expertise in the subject, should automatically be denied a presence on a trust simply because she is married to a Conservative Member of Parliament?

Mr. Blunkett: Certainly not. I make no such presumption. merely know that the people who are declared as, or declare themselves as, Tory councillors or Tory Members, or who are married to, or have been married to, Tory Members, are committed to the Tory cause.
When, last week, the Secretary of State rushed out a response to the working party investigation on corporate governance, she expected us to take seriously the message that major changes would be made to bring about accountability in the service. She spoke of staggering changes, such as the fact that, for the first time, health authorities would have to publish annual reports and, for the first time, non-executive and executive members would have to declare any interests in relation to the health service and in relation to their own trusts.

Mr. Edward Garnier: rose—

Mr. Jerry Hayes: rose—

Mr. Blunkett: I shall not give way, as I have given way sufficiently for the moment.
In the Health Service Journal last week, the Secretary of State said:
Accountability is one of the key ideas and issues that will be concerning the health service in 1994".
It certainly will. We shall want to hold to account those who are making decisions and need to answer to the public about what they are doing. When we table questions in the House, we are met with the blocking response that the information is not collected centrally. We are referred to local trust chairmen and chief executives who are appointed by the Secretary of State, whose remit and survival depend on the Secretary of State and who have no direction to give us the answers.
The pay of those chief executives, chairmen and non-executive members will not be directed by the decision made by the Secretary of State last week on corporate governance, despite the fact that over Christmas the Secretary of State, in the numerous interviews that she gave to the press, gave the impression that it would.
There will be no change; there is no intention to open up the health service. The Secretary of State's proposals on regions make the opposite presumption—instead of regional board members there will be a "respected local

figure". The respected local figures for the eight new zones will, even now, appear on the Conservative central office computer.

Ms Joan Walley: Is my hon. Friend aware that we in Staffordshire face the prospect of losing our ambulance trust, directly as a result of the Secretary of State's failure to be accountable for what is going on? That is simply because there are so many players who are trying to get rid of a good public service and are concerned only about money. Where does accountability lie for the reduction in the rates of pay of my constituents, who are sitting in the Gallery, from £4·85 to £3·26 an hour?

Mr. Blunkett: My hon. Friend is absolutely right. There is no accountability; there is a concentration not on improving the quality and standard of service, but on cost cutting and demoralisation.
Just before Christmas, I was sorry to hear that the Secretary of State had had her handbag stolen. It was stolen from the back of the official car at 11.30 pm, while it was waiting for her outside Annabel's night club after a Tory party Christmas bash. I mention that not merely to draw attention to the fact that the Conservatives have lost any understanding of the line to be drawn between what is right in terms of political responsibilities and what is expedient in terms of personal and political interests, but to show that the Secretary of State should set an example.
When expense on hospitality in the Department of Health goes up by 46 per cent., it is not surprising that people fail to take seriously calls to cut down on waste. The Secretary of State spent £45,000 on overseas visits—the most of any domestic Government Department, and nearly as much as the Secretaries of State for Foreign Affairs and for Defence. She spent £1 million on the good news unit, using our money to promote her propaganda.

Mrs. Virginia Bottomley: Is the hon. Gentleman aware that all the Ministers in the Department of Health underspent their hospitality budget last year?

Mr. Blunkett: The estimates by the Department of Health equate entirely with the incompetence with which it runs the rest of its budget. If Ministers underspent and still had a 46 per cent. increase, Lord help us if they had really been trying.
At Quarry house in Leeds, home of the NHS Management Executive, the Department spent £55 million and provided hand-woven carpets. It cost £30,000 for just three people to travel between Leeds and London. The A to Z sent out from the health service cost £368,000 and contained a wonderful definition of a bed. People up and down the country know all too well that a bed is not a trolley.
Circulars have increased by 100 per cent. in one year and pamphlets cost £800,000 last year. The Secretary of State for Health has become the task force queen of the Government. A task force has been set up for every single month that the right hon. Lady has been Secretary of State for Health.

Mr. Stephen Day: When the hon. Gentleman has finished his long list of personal attacks, smears and innuendo, perhaps he will take some time out to explain the Labour party policy on NHS trusts. He has made contradictory statements in the past and I hope that he will allow us to have a proper debate by clarifying where Labour stands on that matter.

Mr. Blunkett: I will clarify our policy in my own good time. However, our policies will have something to do with treating patients, quality of care and what goes on in the service. I raised issues relating to the Secretary of State because she is in charge and what she does and says matter. Her attitudes pervade the entire service.
It is worth drawing attention to a 19-year-old boy called Dominic who wrote to every member of the Cabinet just before Christmas asking for a donation towards a £1 million appeal to charity.

Dame Jill Knight: That has nothing to do with the motion on the Order Paper.

Mr. Blunkett: It has absolutely everything to do with what we do and how much we care. The Chancellor of the Exchequer gave a tenner, the Chief Secretary gave a fiver. It is relevant, because the Secretary of State for Health sent him a photograph of herself. Sincerity ratings and opinion poll ratings reflect that.

Dame Jill Knight: On a point of order, Mr. Deputy Speaker. Is it in order for hon. Members to make gross personal attacks, nothing whatsoever to do with the motion on the Order Paper?

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): If there had been anything out of order the Chair would have ruled on it. It is a matter for the hon. Member, who is responsible for his own speech.

Mr. Blunkett: I drew attention to what is said and done. We are talking about £1.2 billion being spent on introducing the new system; we are talking about waste and the use of the new market system to increase profits in the private sector by 19 per cent. in the past year; we are talking about he misuse of money merely to manipulate and service the system rather than to provide care.
We are also talking about the ridiculous position of London with the specialty reviews, the Tomlinson review and the Peckham reviews. University College hospital is not threatened by any of those reviews but by the market itself, and the Secretary of State has had to intervene to save that great hospital and its facilities from herself.
Those things matter greatly to every single person. They matter to those who have been waiting 14, 18, 19 or 22 hours on trolleys. They matter to those who have been waiting for operations that have been cancelled again and again. They matter to people who have been told that they could have their operation done if only their GP belonged to a fundholding practice. They matter to people who have seen waste in every area of the service. For example, salaries have risen for senior managers, people have undertaken trips abroad, conferences on waste have cost thousands of pounds.
Nadene Ghouri rightly said in the Evening Standard a day or so ago that one waits for hours and is then told that, if only one would pay, one could have a bed—which was already there and available—for £270 at King's, and that one could be taken off a trolley and given the care that one deserves if one were prepared to pay the money.
We know why people believe that the health service is not safe in the hands of the Secretary of State. We know why people are so angry and frustrated. We know why people wish us to raise the issue of waste at every opportunity. We know why people are asking us, day in and day out, to raise their concerns, which they express at every surgery: why waiting lists and waiting times have

gone up; why there are hidden waiting lists; and why they must wait to see a consultant—the crucial time—so that it can be assessed whether there is an urgent case to be dealt with and urgent treatment to be undertaken.
Those things matter to everybody, but no statistics on those matters are kept nationally. They are not added to the waiting times. The Secretary of State will shortly give instructions for getting waiting lists down for those waiting more than a year. Nobody takes the statistics of those who have never been put on a waiting list, because they have been told that they cannot be given a time and therefore that there is a pending list on which they have to be kept. Nobody would forgive us if we did not raise again and again the need for every pound of our money not to be spent on peripheries, not to be wasted on incompetence, but to be spent on patient care.

Mr. Gyles Brandreth: Given that the hon. Gentleman wants to see more money spent on patient care, why did he oppose compulsory competitive tendering, which is producing some £130 million extra for patient care? That is what the debate is about.

Mr. Blunkett: I think that the term "brass neck" would be an understatement.

Mr. Brandreth: Answer the point.

Mr. Blunkett: I am interested not in cutting the wages of the lowest paid, but in improving the quality of care to the patient and getting people off trolleys and into beds. Today, in its campaign to improve our health service, has provided excellent information, as has the Evening Standard on what is happening in London, the Manchester Evening News in Manchester and the Sheffield Star in my area, and newspapers throughout the country, and the exposure of waste by the Daily Mirror.
All that information is available for people to see. What is more, people also know who benefits from spending and from the health service, not merely those who are placed in positions with which I have already dealt this afternoon. Of the top five beneficiaries who benefit from health service spending, two of them give money to the Tory party: A. A. H. Holdings plc and Glaxo. They will benefit from our money. The hon. Member for City of Chester should not start lecturing about where the money goes or who benefits from it, because some of us could give chapter and verse about how some people have been benefiting greatly from the thrust towards privatisation in the health service.

Mr. Nigel Evans: Will the hon. Gentleman give way?

Mr. Blunkett: I shall not give way.
We know what is happening. The Secretary of State for Wales revealed it all. There is jargon where previously there was common sense, and over-management where previously people committed themselves to service. Episodes of care have replaced counting patients. Activity levels are fiddled by counting those who come back from theatre not only to a different ward but to a different bed, and by double-counting people who have been discharged too quickly and are readmitted for the care that they should have had in the first place. Provider units have replaced hospitals and community services.
I was asked what we would do. We would repay the confidence of the British electorate by treating them with respect and dignity, to restore common sense to our health


service. We would not adopt the "Yes, Minister" approach in which the Secretary of State has been engaged, with private gain at public expense, which is what we have had during the past 15 years. Each year, £85 million goes in tax relief alone for those who are retired and cannot obtain services in the NHS. Insurers provide the facilities that the NHS should provide as a matter of right. That is the truth of the matter.
Again and again, we have raised the incompetence, corruption and nepotism in the Wessex and the West Midlands regional health authorities, or the sell-off of the estates facilities in the South West Thames regional health authority, which reaped one man alone a profit of £900,000. It is no wonder that the British people rally to our support in our fight to cut bureaucracy and to increase investment in the care of patients.
In the year ahead, the British people will see the Secretary of State's capital budget cut by £73 million and there has been a 4 per cent. reduction in the proportion of the health service budget spent on the mental health service, despite the declared commitment to that service, and they will hear the Secretary of State repeating platitudes. No wonder the word "ecology" springs to mind. Recycling the same statistics and verbiage is no substitute for a policy.
Our principles are clear. We want a comprehensive NHS, not a fragmented, destroyed and undermined service, and equal access for everyone at time of need, not GP fundholding undermining that key principle on which we stand. We want a health service that is publicly funded and publicly provided, not an easy killing for the private sector—what Aneurin Bevan described rather graphically as sucking at the teats of the state. We want public accountability where we currently have nepotism, and a free service at the time of need, not charges and private insurance.
That is why I was so interested in the interview—

The Minister for Health (Dr. Brian Mawhinney): For the purpose of clarification, has the hon. Gentleman just announced that the Labour party will abolish charges if it is ever re-elected to government?

Mr. Blunkett: I did not know that the Government were committed to charges for treatment at the time of need. Last year, the Secretary of State went out of her way to say that she was against charging people at the time of need. The Chief Secretary did not. He made it clear that he was in favour of extending all charges—charges for what he calls hotels in the hospital service; charges for meals; charges for what is now known as recuperation, for nursing when one comes out of theatre—which will soon be known as convalescence and charged for. The Secretary of State boldly stepped in to contradict her right hon. Friend, saying that, for the time being, there would be no charges for treatment. And Conservative Members have the cheek to ask me whether we would charge patients for treatment!?
I can think of no better way in which to sum up the Secretary of State's dilemma than quoting from a recent interview that she gave The Spectator.

Mr. Garnier: Will the hon. Gentleman give way?

Mr. Blunkett: No, I will not. I have already given way a number of times, to the detriment of the flow of my attack on the incompetent handling of the health service.
In that interview, the Secretary of State said:

We are like ducks going round in a fairground, and people shoot at you all the time as you go round. In the end, they get you, and the great thing is to know what you will be doing the next weekend.
I know where the Secretary of State will be going. I know where she will find herself when the people of Britain have the opportunity to make a judgment on the Government's stewardship of the NHS—on the way in which they have used resources, the way in which they have undermined the heritage that they received, the way in which they have increased the amount of waste and bureaucracy in the service and the way in which they have undermined accountability. That is why we have moved the motion, and why we have every confidence that people of good will, who are committed to the NHS, will reject the Government amendment.

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from 'House' to the end of the Question and to add instead thereof:
'welcomes the improvement in the efficiency of the National Health Service which has resulted in a substantial increase in the number of patients treated, a reduction in long waiting times for hospital treatment and improvements in the quality of patient care; considers that these improvements show that the health reforms are working and that accountability has been strengthened by the clarification of responsibilities under those reforms; and looks forward to further benefits for patients resulting from proposals announced by the Secretary of State for Health to minimise the costs of administration through the proposed abolition of regional health authorities and streamlining of management.'.
We have just heard a catalogue of vituperation, personal abuse, innuendo and unsubstantiated smears. Once again, the one thing that we have not heard is a policy: this is a policy-free zone, as it has been before.

Mrs. Jacqui Lait: I listened carefully to what was said by the hon. Member for Sheffield, Brightside (Mr. Blunkett). I fear that I must disagree with my right hon. Friend according to her, the hon. Gentleman said nothing about policy, but I picked up two ideas—albeit meager—from what he said. The first is that, if Labour ran the health service, there would be centralised control of information; the second is that there would be public accountability. Does my right hon. Friend agree that that public accountability would lead to a trebling of a number of committees in the health service? That is what happened in Sheffield when the hon. Gentleman led the council.

Mrs. Bottomley: Yes, indeed. My hon. Friend is entirely right.
As I was saying, we have again been confronted with a policy-free zone, empty of substance. As always, the hon. Member for Sheffield, Brightside (Mr. Blunkett) condemned and talked down the national health service, rather than pay tribute to the dedicated staff who work in it, providing ever higher quality care.
Ministers give an account of their stewardship of the health service every month at Question Time, and in Adjournment debates and statements. Even when they give their account of developments to the press, the hon. Member for Brightside complains that there are too many press interviews and press notices—simply because, yet again, they highlight the bankruptcy of his own position. He asks a good many questions. During a recent period,


Opposition spokesmen asked 1,400 questions, at a cost of £144,000: they cost £97 a go. However, I am grateful to the hon. Gentleman.

Mr. Andrew Faulds: On a point of order, Mr. Deputy Speaker. Is it not rather inadvisable of this young woman—she supposedly is a Minister—to question the right of hon. Members to table questions, regardless of cost, when she is the most incompetent Minister in an incompetent Government?

Mrs. Bottomley: I was going to suggest to the hon. Member for Brightside that requests for me to list NHS expenditure, in the latest year for which figures are available, on surgical dressings and bandages, broken down into the country of manufacture, were not particularly necessary to the careful stewardship of the national health service, bearing in mind the fact that each question happens to cost £97.
A year ago, we charged the hon. Member for Brightside to explain his policies but we are still waiting. Would he abolish NHS trusts? We heard an interesting intervention from the hon. Member for Stoke-on-Trent, North (Ms Walley) who seemed particularly distressed at the prospect of her trust being dismantled. Would the Labour party dismantle the health reforms or does it accept that they are here to stay? We have waited a year but printing machines have failed to roll. The questions are still unanswered; the policy zone is still deserted.
The answer to the question, "What is Labour's health policy?" is that Labour's health policy is due out next month. As far as I can tell, that has been the position since the general election and it was certainly the position when last month the hon. Member for Brightside gave a short interview about his policies. However, next month has arrived and the hon. Gentleman is still silent. He is the mafiana man, always putting off until tomorrow what he should be doing today.

Mr. George Stevenson: On the subject of NHS trusts, does the Secretary of State understand that the split between purchaser and provider is widening and that patients are falling into the gap that is being created? For example, a 90-year-old constituent of mine, who was taken to a trust hospital for a head injury, complained of rib pains, was sent home without an examination and was later found to have broken ribs. That occurred because the hospital needed more beds. Is that the sort of policy that the right hon. Lady promotes? Is that the sort of service that people deserve?

Mrs. Bottomley: There are few thinkers who do not believe that the distinction between the task of assessing health need and purchasing health care and the task of providing for patients is better separated. They are different jobs and separation provides the opportunity to develop a strategic framework to improve the health of the nation. The health reforms, which will ensure that money is not used merely to prop up institutions but has a strategic purpose, are of profound importance.
It is a source of great regret that the Opposition are not interested in debating or willing to debate in detail the complexities of making the system even better. Had they been interested, I should have referred the hon. Gentleman to, for example, the speech by Sir Duncan Nichol, the chief

executive of the NHS, in which he talks about the importance of purchasers and providers working together and to repeated statements by Ministers to the effect that it is important that there is a spirit of trust and co-operation between the districts and the general practitioners and between the hospitals and the clinicians who work in them. Out of that new system comes an opportunity to develop a health service that meets the health care needs of his and all of our constituents much more effectively.
The sadness of the Opposition, who are dominated by the trade union movement, is that they talk constantly of the reactionary, the fossilised and vested interest but they have no interest in patients or in progress.

Mr. Rowe: Is not it true that in the mafiana republic that the hon. Member for Sheffield, Brightside (Mr. Blunkett) wishes to establish we would return to a provider-driven service? Is it not perfectly clear that one of the enormous advantages of the purchaser-provider split is that it has rendered the accounting transparent? That, in turn, has made it much harder for people to get away with a range of little abuses that have crept in, such as the use of NHS equipment in private practice. Is not that a clear example of value for money?

Mr. Deputy Speaker: Order. Interventions are supposed to be short but the two that we have just heard have been rather lengthy. If that continues, the many hon. Members who want to catch my eye will be disappointed.

Mrs. Bottomley: I shall try to resist inteventions for a while but, Mr. Deputy Speaker, you will appreciate that I have a great commitment to the changes that we are setting in hand and my hon. Friend the Member for Mid-Kent (Mr. Rowe) raised precisely the sort of point which proves that we are becoming ever more effective in improving the quality and quantity of care that we are able to deliver.

Mr. Thomas Graham: rose—

Mr. D. N. Campbell-Savours: rose—

Mrs. Bottomley: I hope that the hon. Gentlemen will bear with me. It is my way to give way but I fear—

Mr. Campbell-Savours: rose—

Mr. Deputy Speaker: Order. It is fairly obvious that the Secretary of State is not giving way.

Mrs. Bottomley: Of course there are times when things do not go as they are intended. There are times when patients are treated unacceptably but, of the 8 million in-patients treated, the vast majority express great satisfaction with the care that they receive. When things do go wrong, it is right for us to take action.
One such example is the case of the lady mentioned by the hon. Member for Stoke-on-Trent, South (Mr. Stevenson) who had to wait an unacceptable length of time on a trolley in an accident and emergency department where an £8 million investment programme is under way to extend it. It was, nevertheless, an unacceptable state of affairs which is why I have today written to health authorities to ensure that they have the proper A and E arrangements in place, that they have provision for a service that is subject to unpredictability, that they have the spare capacity and that patients are always treated with dignity and courtesy.

Mr. Campbell-Savours: rose—

Mrs. Bottomley: I cannot give way as I need to make further progress.
The hon. Member for Brightside refers with scorn and abuse to all those who spend their time working in the health service. He speaks vindictively of those he describes as
non-caring, non-patient—orientated"—[Official Report, 21 October 1993; Vol. 230, c. 400.]
meaning the white collar workers in the NHS. It is not good enough for him then to say that he has in his sights only the senior executives or some group that he associates with the reforms. It is important to make it clear that general and senior managers account for only 3 per cent. of the NHS wage bill and 2 per cent. of the work force. They are tiny figures.
The figures that the hon. Member for Brightside frequently quotes as a damning indictment of NHS bureaucracy include, for example, the medical secretaries who provide the invaluable back-up to doctors, freeing them to spend more time with patients. Is the hon. Gentleman, in his abuse of managers in the service, saying that medical records should not be filed or patients' notes typed? Is he saying that such people are "non-caring, non-patient orientated?" He should apologise for his remarks which belittle and insult the hard-working members of the NHS. As ever, his comments show the bankruptcy of his arguments.

Mr. Blunkett: Statistics provided by the right hon. Lady's Department show that senior management costs have risen from £25 million to £494 million and that last year trusts spent £24 million on cars compared with £5 million the year before. Where do medical secretaries feature in those statistics?

Mrs. Bottomley: The hon. Gentleman is adding apples and pears; he is not comparing like with like. There has been an increase in the number of managers, in large measure because of the reclassification of a great number of senior nurses. The fact remains that whereas, 10 years ago, 60 per cent. of our staff were involved in direct patient care, the figure has increased to 65 per cent.
Our record is commended around the world. We concentrate on meeting patients' needs and we do so effectively. The question that the hon. Gentleman should ask is, what is the added value from the management input in the health service? The answer is the delivery of extra patient care, falling waiting times and improved quality, which is so important.

Mr. Graham: Will the right hon. Lady give way?

Mrs. Bottomley: I shall give way for the last time and then I must make headway.

Mr. Graham: I am delighted that the Minister has agreed to give way.
The citizens charter, which promised our constituents that they would be treated or get an appointment in a certain period, is absolutely horrifically not working in my constituency. One of my constituents has been waiting five months for an appointment with a urologist. I have been told by a local doctor that it will be more than 19 weeks before they can get an appointment to meet a urology consultant. Is that the type of health service that we are running for our constituents?

Mrs. Bottomley: The House must be aware that before the health reforms more than 200,000 people were waiting for more than a year and many people were waiting for more than two years. We have seen a plummeting in the long waiters and a substantial reduction, in the year, of more than one year waiters. There has been progress in the health service and transparency for patients because the patients charter explains to patients precisely to what they are entitled. That is because of the greater transparency, the better organisation and the commitment by the Government to the NHS.
My hon. Friends on the Conservative Benches will remember the Cook test, named after the hon. Member for Livingston (Mr. Cook), who radically challenged us to measure the success of trusts by the simple test of whether they do more or less work for patients. Now that those trusts are indisputably doing more work for patients, the hon. Member for Livingston conveniently finds himself with new duties, but the hon. Member for Brightside is left to wriggle and squirm his way out of that hole. That is why he will count the number of beds, bandages or of press notices—anything but patients. The hon. Member will not recognise that it is the patients who count.
The hon. Member for Brightside forgot to mention in his speech that the NHS hospitals are on course to treat 8 million patients this year. That is 1 million more than in the year before the reforms, but it is 3 million more than it was when the Labour party was in power. [Interruption.]

Mr. Deputy Speaker: Order. The Secretary of State has made it very clear that she will not give way.

Mrs. Bottomley: The hon. Gentleman forgot to mention that trusts have increased their patient activity even faster than other hospitals. He forgot to mention that for every 100 patients treated in hospital before the reforms 116 are treated today, and next year it will be 120. He forgot to mention the rapid increase in day surgery and childhood immunisation and in the quality of care.
The hon. Member for Brightside spoke about waiting lists. He forgot to mention the 51,000 patients who, before the reforms, were waiting more than two years; there are none today. He never gives credit. He certainly did not mention that before the reforms the average wait was nine months; that has now decreased to five months. Ten years ago, only one in eight patients were able to have a hospital operation and go home the same day. That is now one in four.
That is what our-policies are achieving. The Labour party cannot bear to hear the accurate statistics of the achievements of the national health service because the figures highlight even more clearly its abject failure to come up with a policy. [Interruption.]

Mr. Deputy Speaker: Order. It is fairly obvious that the Secretary of State is not giving way at this stage.

Mr. Graham: On a point of order. Mr. Deputy Speaker. I thought that debates were an opportunity to give Back Benchers a chance to question the Minister. It is difficult for us to do a good job if we cannot get a chance to do so.

Mr. Deputy Speaker: The Secretary of State is responsible for her own speech and whether she gives way.

Mrs. Bottomley: I think that I have given way as much as, or probably more than, the hon. Member for Brightside. Opposition Members do not wish to have an informed


debate. They seem to wish to make a great noise because they want to obscure the achievements of the national health service.

Mr. Mark Wolfson: I am most grateful to my right hon. Friend. She is making a robust defence of the strategic changes in the health service and I commend her fully for that. May I say, however, that there is concern among many general practitioners in my part of the country about the quantity of statistics—which she recently mentioned—which they have to provide. At this stage they do not receive enough information about the usefulness of those figures. I hope that she will regard that as a constructive contribution to the debate, in contrast to the attacks that she has received from Opposition Members.

Mrs. Bottomley: That is an extremely constructive contribution because it highlights one of the dilemmas or complexities that confront us. We have to be accountable for the work that is undertaken by general practitioners; we have to ensure that there is a comprehensive health service; we have to have control, not only of the financial aspects, but of the quality of clinical care. Every time that a form is filled in, however, there is a distraction. That is time that general practitioners would rather spend with their patients. I hope that we shall find more simplified ways of satisfying the proper interests of general practitioners as well as, rightly and properly, the need for accountability and the stewardship of the national health service.

Mr. Campbell-Savours: rose—

Mrs. Bottomley: I think it would be fair to say that I have given way to Labour Members twice as many times as I have to Conservative Members. I do not wish to fall out with my hon. Friends and, therefore, for fear of getting into difficulty with them, I must demonstrate some sense of balance and order in the number of occasions on which I give way. When I have given way to an equal number of Conservative Members I will try to give way to Opposition Members once again.
You will appreciate, Mr. Deputy Speaker, with the substantial advances that I have identified, that the Labour party—

Mr. Home Robertson: On a point of order, Mr. Deputy Speaker. Will you start a waiting list for Members who want to intervene in the debate?

Mrs. Bottomley: I suggest that Labour Members put their name down on the waiting list for a Labour party policy on health because if ever there was a case of, "If in doubt, shout", it is the Labour party: It has no policy. The nerve of asking for a debate which simply gives my hon. Friends the opportunity to expose the Labour party's policy-free zone defies all description. We had thought last week that the antics of Labour Members were a result of their deciding at the last possible moment that they could not brave a debate, and were a way for them to pull the plug on it. Be that as it may, all day today the hon. Gentleman will have to put up with my hon. Friends asking time and again, "Where is the policy?" That will not deflect me from continuing to give an account and an explanation of those important changes.
We take the view that the way in which resources are managed is of crucial importance to delivering quality and

cost-effective patient care, but we also accept that the resources are important. That is why, this year, we have more than met our manifesto commitment. NHS spending is already at record levels and it will increase next year by a further £1·6 billion—equivalent to an extra £83 for every household.
I notice that last week in the British Medical Journal the hon. Member for Brightside said that he hoped that the Labour party would make a specific commitment on NHS funding. I hope so too, after the consultation. We are sick and tired of being told that the health service is underfunded, by a party which refuses time and again to say by how much health spending should increase.
Last month, however—Labour Members may wish to listen to this—the hon. Gentleman said that a Labour Government would aim to take Britain into something called "the 7 per cent. club", by which he meant the group of nations who spend at least 7 per cent. of gross domestic product on health services. Is he aware that the policy would cost the British taxpayer an extra £6 billion? Will he confirm whether that is now Labour's firm commitment? Will he confirm whether he has the express permission of the shadow Chancellor to make that commitment?
While the hon. Member for Dumfermline, East (Mr. Brown) is telling the British taxpayers, "Honest, guy, we've gone straight," the hon. Member for Brightside wants to pick £6 billion out of their pockets. Perhaps the hon. Gentleman wishes to confirm the status of his commitment to spending an extra £6 billion on health. Would he like to intervene?

Mr. Campbell-Savours: rose—

Mrs. Maria Fyfe: rose—

Mrs. Bottomley: It seems that the hon. Member for Brightside does not wish to substantiate the claim that he made last month. No doubt my hon. Friends, and their constituents, will be extremely worried about that aspect of Labour party policy.
The truth is that in government Labour cuts spending and in opposition it cuts commitments. The Government have done neither. We have cut out waste and improved efficiency. Since we came into office the number of patients treated in hospitals has increased nearly three times as fast as spending, even when that is adjusted for inflation. In the 1980s the number of patients treated in hospital grew on average by 2·5 per cent. a year.

Mr. Graham: The health of the nation is deteriorating.

Mrs. Bottomley: I must respond to that off-side intervention. The hon. Gentleman says that the health of the nation is deteriorating, but he may like to know that over the past 10 years the number of people who die below the age of 65 has fallen by one fifth, the number of babies who die in their first year has fallen by two fifths, and average life expectancy has increased by two years. I regard that as a substantial improvement in the health of the nation.

Mr. Campbell-Savours: rose—

Mrs. Bottomley: I am seeking—

Mr. Home Robertson: rose—

Mr. Deputy Speaker: It is fairly obvious that the Secretary of State is not giving way.

Mrs. Bottomley: Labour Members may wish even less to hear what I have to say next. In the 1980s the number of patients treated in hospitals grew on average by 2·5 per cent. a year; in the 1990s, since the reforms, that number has been growing by 5 per cent. a year, and even faster in the trusts. Under the Labour Government activity grew by little more than 1 per cent. a year. The improvements are essential if the health service is to keep pace with the demands on it. That is why, as well as maintaining our spending commitments, we shall continue to demand tough efficiency improvements from the health service.

Mr. Hughes: rose—

Mrs. Bottomley: It is not how much one spends, but what one does with it.

Mr. Hughes: Will the Secretary of State give way, on spending commitments?

Mrs. Bottomley: I have no need to give way on spending commitments. A Government who have given an extra £1·6 billion this year do not need to give further explanations of spending commitments.
For the coming year we have set a target of 2·25 per cent. for efficiency gains, which will release an extra £450 million to spend on patient care. It is no coincidence that those dramatic improvements in the number of patients treated have taken place as the Government deliberately strengthened NHS managers. Leaders of the profession agree.
Christine Hancock, for example, recognises that that process was needed, and indeed overdue. Sir Roy Griffiths, whose management reports in the mid-1980s were so important, said that if Florence Nightingale were carrying her lamp through the corridors of the NHS then, she would almost certainly be searching for the people in charge. In the unmanaged shambles that we inherited from the Labour party it was impossible to reduce costs because nobody knew what costs were. Better management has meant that we have been able to cut waste by improving services and service delivery.
Take, for example, the supplies authority—

Mr. Campbell-Savours: rose—

Mr. Brian Sedgemore: Give way, give way.

Mrs. Bottomley: Last year and this year the NHS supplies authority has saved £84 million. In addition it has just negotiated a deal with British Telecom to save several million pounds through its contracts. Better management has cut energy consumption. The hon. Member for Brightside pours scorn on the "A to Z of Quality", but the idea has brought forward practical initiatives throughout the health service, and people are taking those achievements forward. The hon. Gentleman is pouring scorn on the efforts of nearly 3,000 NHS staff who have submitted their ideas for individual cases to be selected.

Mr. Campbell-Savours: rose—

Mrs. Bottomley: In just one example, in the constituency of the hon. Member for Wakefield (Mr. Hinchcliffe), energy management—

Mr. Sedgemore: Give way, give way.

Mr. Deputy Speaker: Order. It is a matter for the Secretary of State whether she gives way or not.

Mr. Sedgemore: Why does she not give way? There is something wrong with her.

Mrs. Bottomley: One of the examples—[interruption] Once again, Labour Members do not want to hear the facts of the situation. One of the examples in the "A to Z of Quality" concerns the constituency of the hon. Member for Wakefield, where the energy management project is saving £370,000 a year. That more than covers the costs of the "A to Z of Quality", and the money is all being spent on patient care.
We have cut waste by contracting out services. Competitive tendering across an ever widening range of services has led to savings of at least £130 million a year. The Labour party fought those changes and it fights them still. That says more about its real commitment to rooting out waste in the health service than all the spurious facts and figures cited by the hon. Member for Brightside.

Mr. Campbell-Savours: Will the Secretary of State give way?

Mrs. Bottomley: The hon. Gentleman has ground me down, Mr. Deputy Speaker.

Mr. Campbell-Savours: Contrary to what the right hon. Lady has been saying, some Labour Members are very happy with the treatment that we have had in the national health service, and we are prepared to say so publicly.

Mr. Sedgemore: Where was the treatment? St. Bartholomew's.

Mr. Campbell-Savours: However—

Mr. Sedgemore: The Secretary of State is closing down the hospital that saved my hon. Friend's life.

Mr. Deputy Speaker: Order. The hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) must control himself.

Mr. Campbell-Savours: When one is in hospital one hears when things go wrong. I can tell the Secretary of State about an incident one evening in Bart's when the accident and emergency department was 33 beds short. The chap responsible for running the whole hospital decided that the staff had to put beds on the floor—

Mr. Sedgemore: Mattresses.

Mr. Campbell-Savours: I am sorry, it was mattresses. They had to put mattresses on the floor to take in the extra patients in accident and emergency. Someone then telephoned throughout London to find out whether there were additional beds available in any other accident and emergency department, or in any other ward in any other hospital. Bart's telephoned 17 hospitals, and could not find a bed. So we cannot understand why, at the same time—

Mr. Sedgemore: She is shutting the A and E unit.

Mr. Campbell-Savours: We cannot understand why the right hon. Lady is deciding to shut the accident and emergency unit in the hospital where I was. Where is the sanity in that policy?

Mrs. Bottomley: Again, I ask Labour members to read the informed and sensible debate on change in London that was led by their spokesman in the House of Lords. She said, as the hon. Gentleman must also say in his more


rational moments, that no change is no option in London. Of course having first-rate A and E services is essential for the change. That is why we are putting nearly £15 million more into the London ambulance service.
Meanwhile, there is a major development programme at the Homerton, increases at the Royal London, improvements in the A and E at St. Thomas's and £8 million being spent at King's. Those who take a more serious interest in the health service will know that one of the dilemmas in London is caused by the fact that people frequently use A and E services where elsewhere they would use primary care. If the hon. Gentleman cared to consult Professor Lesley Southgate, professor of general practice at St. Bartholomew's hospital, he could have an informed discussion about the importance of change in London and of developing primary care, and about the phenomenal unprecedented investment that is under way, taking forward 100 primary care schemes across London this year. That is a necessary programme of change.
I understand the concerns of those most directly involved. I also know that it would be unforgivable, in the light of all the changes, and all the medical advances, to fail to grasp the nettle. I admire Labour Members who constructively and responsibly seek the right outcome rather than simply holding on to the latest fashion and resisting change. It is that approach which makes them unfit ever for government and ever again for stewardship of the national health service.
This debate is of great importance and there are further matters which I wish to raise. We have announced recently that we wish to streamline the management of the NHS. Every change requires review and further development. We have had a successful drive towards decentralisation. We want patients closely involved and we want decisions to be made as close to patients as possible. Now is the time to sweep away a layer of administration. That is why I have announced proposals to abolish the 14 regional health authorities, to reduce further the number of health authorities by allowing district and family health service authority mergers and by streamlining the management executive. Those proposals received a broad welcome, both inside and outside the health service.
Of course, as ever, the hon. Member for Brightside could not bring himself to share that welcome. Once again, he talked about cutting out waste and when we take action to do so, he is lost for words. The proposals will mean that the management of a decentralised health service is even more effective and they will save money on administration to be spent on patients. That process is already well under way. Take, for example, the Northern regional health authority.

Mrs. Fyfe: On a point of order, Mr. Deputy Speaker. Do you agree that it is a disgrace that there is no Minister from the Scottish Office present so that we have some idea of whether the Secretary of State's proposals will also apply to Scotland?

Mr. Deputy Speaker: That is not a matter for the Chair and the hon. Lady knows it.

Mrs. Bottomley: I was referring to the Northern regional health authority, which plans to save more than £3 million on administration over the next two years to be

spent on patients—including reducing waiting times. East Anglia health authority expects to save £1·6 million and to use that extra money to deliver 4,000 patients treatment.
The hon. Member for Brightside referred to accountability, which is an enormously important subject in a service as sensitive and as complex as the NHS. We will uphold and strengthen the accountability of the NHS to Ministers and to Parliament. The public must continue to have confidence in the stewardship of the taxpayers' money spent by the health service. Citizens and taxpayers have a right to expect those who use their money to provide services to carry out their jobs with responsibility, with honesty and to the highest possible standards. No one can give a guarantee that nothing will ever go wrong, however the health service is managed. What matters is to throw the spotlight on such matters and to take the necessary action.
I remind hon. Members that it was this Government who opened the doors of the health service to the independent external scrutiny through the Audit Commission. The Labour party was quite content with the cosy, secret world of closed books behind closed doors. We are determined that there should be a rigorous system of accountability with external audit and that lessons should be learned when things go wrong. The vast majority of NHS work is characterised by dedication, responsibility and honesty. This year, the Audit Commission reported that the overall financial management of all NHS activities has shown a significant and welcome improvement. It is disgraceful that the Labour party should use isolated examples to cast a slur on the integrity of the majority of men and women who work in the health service.
It is right that in the light of the important Cadbury report on corporate governance, and in the light of recent, justified criticism from the Audit Commission and the Public Accounts Select Committee, we have been working to look again to develop codes of conduct and accountability in the NHS. Once again, the hon. Gentleman poured scorn on the use of task forces in the NHS. In a service as complex as ours, the involvement of people working, rather than the loudmouths of the Opposition, is a better way in which to deliver policies which will work in practice. I pay tribute to all those who have helped the task forces on corporate governance, on accountability and on the code of conduct.
Those codes will play a key role in strengthening accountability, probity and financial control. They re-affirm long-standing good practice in the NHS and state unambiguously that NHS boards are responsible for ensuring effective financial stewardship through value for money, financial control and financial planning strategy. The codes include new measures which will require the directors of boards to declare private interests, require boards to establish audit and remuneration and terms of service committees, to keep proper control over the pay of chief and senior executives, and will require pay and remuneration packages of both executive and non-executive board members to be published in annual reports.
The information revolution is already under way. In the past, no one knew who was in charge of a hospital. The establishment of trusts, the requirement to produce annual reports, to produce accounts, to have a public meeting of the trusts, apart from the work of the health authority means that the amount of information that is now available is unprecedented. I look to chairmen personally, with the


full support of non-executive members and chief executives, to take a lead in implementing those codes. They must lead by example.
Labour Members delivered their usual catalogue of abuse against those who serve as non-executives on the NHS trusts and authorities. I find that unbelievable because I believe that there is a tradition in this country of public service and service for the NHS which transcends political parties. I remember Lady Callaghan only too well when she was chairman of Great Ormond Street hospital. I remember any number of spouses of Labour Members taking a key and influential role and that there are any number of individuals throughout the service of all political parties who are serving the NHS trusts.
I am pleased, from what I gather, that the Opposition are no longer actively discouraging their members to serve on trusts and authorities. Too often in the past, it was reported that there was pressure put on members of the Labour party not to serve on trusts and authorities.
The way in which chairmen of health authorities have been appointed has varied little over the years since 1948. I suggest that the Labour party puts forward its own good names and support people who are doing an extremely good job and recognise the great quality of the contribution of the non-executive members. For example, Dame Margaret Turner-Warwick, the previous president of the Royal College of Physicians, is now the chairman of the Exeter NHS trust. There are any number of examples of people from all ranges of activities who are contributing to the national health service.
The hon. Member for Brightside knows that whatever accusations he has made against the health reforms, they have been widely accepted in and beyond the NHS. His dilemma, and it is a real dilemma as my hon. Friends will know, was summed up by the founder of the Socialist Philosophy group, Professor Julian Le Grand, when he said of the Labour party in an article in the New Statesman:
If they refuse to believe that there are positive features of the reforms, they can call for their complete withdrawal. But then they have to offer something else that would do better. It is far from clear what that would be. Certainly few who work in the NHS would want to go back to the old pre-reform system. And even fewer would relish the prospect of yet another dramatic upheaval regardless of what form it took.
Elsewhere in the article, the professor states wisely:
central planning was not a conspicuous success in the old health
service
and he describes GP fundholding, which is always denigrated by the Labour party, as "perhaps the biggest success story" of the NHS reforms. If that is what constitutes socialist philosophy in revisionist times, I. have a great deal more time for it than the half-baked denigrating variety served up by the hon. Member for Brightside.
The hon. Member for Brightside has no answer to the increasing success of the health reforms, he has no answer to the improved efficiency of the health service, he has no answer to the extra spending, and he has no answer to the millions more patients who are treated. The hon. Gentleman has no answer to the dramatic falls in long waiting times, and no answer to the improvements in patient care which are taking place in every hospital, every clinic and every GP's surgery. His sole response is to spread scares, smears and innuendos against people in the NHS. His mean-spirited attacks lack recognition of all that the staff have achieved in the past three years. They have taken change on board and they have made it work for the benefit of patients.
We have begun a great journey with our health reforms, and that journey must and will go on. We will make the health service even more responsive to the ever-changing needs of the population and the ever-widening capabilities of science. The hon. Gentleman, in one of the rare sane moments in his speech, referred to the important but deeply concerning matter of human fertilisation and embryology. I will certainly talk with others about a possible debate on it. This country was indeed ahead of others in setting in place legislation to control those new techniques. That was a forward-thinking and enlightened piece of legislation, and so also are the health reforms a forward-thinking, enlightened piece of legislation, which will encourage diversity of care, not just in hospital but across the range of settings.
We will harness the health service single-mindedly to the goal of improving the nation's health. We will keep the health service at the leading edge of modern medicine. In practice, it must always be informed by the best and the latest medical knowledge. It must be clinically effective as well as cost-effective. Above all, we shall ensure that patients are treated with the courtesy and dignity that they deserve. Their needs, their choices and their well-being come before all else. Our health reforms are the means to those ends. They will uphold and strengthen the integrity and dynamism and the value of our NHS now and into the next century.

Mr. Martin Redmond: I shall be brief. The Secretary of State and her mouthpiece, the right hon. Member for Peterborough (Dr. Mawhinney), should be congratulated on their skilful misuse of NHS statistics and accounts which could lead one to believe that they were the grandchildren of Goebbels, for they regularly use his propaganda skills. Two and a half decades ago, when he was a Health Minister, Enoch Powell referred to NHS statistics as a pack of lies. He would not be so complimentary now.
The Secretary of State continually claims that never before has the NHS been so well run. NHS trust chairmen and chief executives tell her that, but that is no surprise. She says that never before has so much been spent and so many patients treated. Those comments are the deliberate, cynical misuse and falsification of facts and statistics. The Secretary of State should know that the form of NHS accounts and statistics was so substantially changed on 1 April 1990 that comparisons before and after that date are virtually impossible. I am aware of an in-patient case which involved at least four consultants by the time surgery took place.
In recent days, the Secretary of State has thrust herself forward as an exponent and promoter of "back to basics''. Although that was clearly designed to camouflage Government incompetence, she should at least present facts to the public without criminal distortion. Let us hear of a few basics which the Secretary of State has not seen fit to publicise.
First, no chairman or non-executive director of an NHS health authority or trust is democratically elected, yet we hear much criticism from Conservative Members about trade unions. Conservative NHS appointments are more akin to the Nazi gauleiter system. Secondly, in 1993–94, NHS chairmen and non-executive directors will receive about £50 million in salaries and expenses. That sum


would pay for 40,000 in-patient cases. Some non-executive directors have received more than £500 per meeting attended.
Thirdly, since 1990, chief executives and immediate managers have doubled or trebled their pay. During the same period, caring staff received little more than a 10 per cent. increase. Fourthly, extravagance is rife. It is only in the past few years that a manager would have had the affront to travel by Concorde at public expense, without a word of criticism by the Secretary of State.
Fifthly, vastly increased expenditure on managers' cars has been incurred, despite their having little need for them. However, district nurses need cars. Sixthly, over the past three years, the cost of managers and management has increased by about 1,500 per cent.
Seventhly, contractual mismanagement on a scale unheard of in the public service has occurred in two regions, costing tens of millions of pounds and, sadly, depriving tens of thousands of patients of treatment. What has been the Secretary of State's reaction? She rewarded the chairman of one regional health authority with the chairmanship of the national supply committee, and, on his resignation, she made Sir James Ackers the unique gift of £10,000 from public funds, thereby happily compounding the regional health authority's action in making illegal payments to senior officers rather than dismissing them. The Secretary of State would learn something if she listened rather than rabbited.
Eighthly, nurses who were still waiting for grading settlements five years after their 1988 grading restructuring were refused interest on moneys outstanding. That is the meanness of the Secretary of State. Ninthly, in-patient waiting lists remain immense, despite dodges such as putting patients on 12-month out-patient review or delaying out-patient appointments falsely to understate the waiting list.
Tenthly, there has been the highest ever reduction in the number of posts for caring staff, to fund the highest ever costs and staffing levels of administration and management. Eleventhly, the sum of nearly £1 billion, which was spent on computers, management and accounting systems to support the market style of management, would have paid for the treatment of the greater part of the in-patient waiting list, as declared by the Secretary of State.
Twelfthly, the Secretary of State has consistently refused to order public inquiries into the deaths or permanent damage of children in hospital—no doubt, to suppress the truth—and, at the same time, delayed the payment of damages which could have improved the life styles of some unfortunate children. The Secretary of State should be ashamed of herself.
Last week, Public Finance and Accountancy quoted the Secretary of State as saying:
Review bodies must look at pay in the context of what is affordable.
I have yet to hear her say that regional health authority corruption and incompetence are unaffordable. As stated earlier, they are well rewarded in the West Midlands regional health authority. It has also been feared that the 1,500 per cent. increase in managers' pay is not affordable. The statement of the junior Minister—
we make no apology for the small real increase in senior managers—

is pathetic and shows not only the Government's ignorance but their indifference to the sick. I call on that Government to order a 10 per cent. per annum reduction in the number of all health authority and trust managers and their pay over each of the next five years as a start to restoring the balance between those who care and those who live on their backs.
"Back to basics" in the health service creates unemployment among nurses and the lowest possible pay, with the exception of top management who are rewarded with massive pay and rewards for mindless loyalty. Back to basics—so much for sound economic management. Anything is affordable to avoid publicity. Back to basics—justice and fairness are not applicable to nurses, only to those who promote Tory policies. Back to basics—never let the public know the truth.
I could go on, but time is limited. In the past five years, we have seen a massive growth in corruption and gross management incompetence throughout the national health service at the same time as the last elements of accountability of chairmen and directors have been removed. The Secretary of State can take notice of whichever of the Prime Minister's back to basic principles she chooses. But she and her team should resign and let us get back to running the national health service.

Mrs. Marion Roe: I am grateful to have the opportunity to speak in the debate. Unlike Labour Members, I see the latest management changes introduced by the Secretary of State as another constructive step towards the Government's goal of achieving an appropriate and accountable management structure in the national health service.
I remember that, not long ago, the national health service had no management structure of which to speak. Those were the days when no one could provide even the most basic information such as the number of doctors employed in the NHS, the bed occupancy rate or even treatment costs. As Sir Roy Griffiths said in 1984, there was no one "in charge" and no one could be held to account for the billions of pounds of public money that were being poured into the service. What was needed was nothing less than a management revolution to give the health services the sort of management that was capable of handling its huge resources.
I am proud that the Conservative Government grasped the nettle in the early 1980s and have continued to pursue their aim of improving management performance. I remain convinced that only through good management can the health service continue to deliver the range and high standard of services that are demanded by rising public expectations and increasing medical capability.
Anyone who is acquainted with the reforms introduced in the past 15 years will understand that changes on the scale that have been achieved could not be introduced overnight. There had to be a clear strategy with every stage building on the previous one. The introduction of general management and the various management initiatives of the 1980s strengthened and increased the role of management.
The breadth of the reforms introduced by the National Health Service and Community Care Act 1990 added new dimensions and new responsibilities as the internal market developed. I want to take this opportunity to congratulate


the scores of managers who have worked stoically to improve services for patients as well as implement the many changes that are expected of them.
One year ago, the Select Committee of Health, which I am privileged to chair, published its interim report on the NHS trusts. The Committee recognised the long-term contribution that trusts are making, and will increasingly make, to the health service. However, we expressed the view that the rapid expansion of trusts was in danger of causing a potential loss of strategic planning, especially at the regional level. We asked that consideration be given to the way in which the roles of the regions and the NHS management executive outposts could be accommodated with the freedom of the trusts. It seemed to us that there was a proliferation of management as a result of the new system growing up alongside the old, largely centralised management structure.
I am satisfied that the Secretary of State has responded to that concern. Her latest announcement on the structure of NHS management will ensure that the best parts of the old system are fully integrated with the new. The reduction in number and slimming down of regions, the merger of the outposts with regions, the review of staffing in purchasing authorities and the merger of districts will all contribute to slimlining the management structure. In addition to that top-down rationalisation, as the structure settles down and individual managers gain confidence, they are achieving their own improvements.
In my constituency, the East Hertfordshire NHS trust, which covers patients living in my constituency, has reduced the number of its full-time managers by nearly one third, from 50 to 35, since trust status was achieved. Management costs are also down to less than 2 per cent. of the total budget. Yet all contracts in 1992–93 were delivered within budget, and it is expected that they will be again in 1993–94.
In any large organisation, integrity is an absolute prerequisite, especially when large public funds are at stake. I welcome the positive steps taken by the Secretary of State to strengthen accountability, probity and financial control in the NHS. The codes of conduct and accountability that she proposes to introduce will reaffirm the long-standing good practice in the NHS and set out clearly the corporate standards that people can expect from the NHS boards.

Mr. Nicholas Winterton: Will my hon. Friend give way?

Mrs. Roe: I will not give way at the moment. Mr. Deputy Speaker has already said that many hon. Members wish to speak. I know that my hon. Friend will be speaking later, and he can make his points then.
With an organisation as vast as the NHS, good management is essential for higher productivity and better efficiency. Good management pays, as the performance of my local NHS trust has shown. I am proud to be able to tell the House that, without any subsidy, the trust complied with its financial duties in the first year and broke even. This year, it is on target to achieve a similar result.
All that was achieved while there was an overall increase of 4 to 5 per cent. in patient care. Improvements in waiting times have been made—over 85 per cent. of patients are seen by a consultant within 30 minutes of the time of the original appointment; improvements in support services have been made—for example,. 95 per cent. of

patients attending the East Hertfordshire trust accident and emergency department are seen immediately by a senior triage nurse; the trust has efficiently managed a 10 per cent. increase in attendees in the accident and emergency department in 1993–1994; and day surgery output increased by more than 20 per cent. in 1993. Those are facts. East Hertfordshire trust has been reported as the top provider in the North West Thames region on the patients charter monitoring. None of that suggests to me that this is a service in decline—far from it.

Ms Liz Lynne: I welcome the opportunity afforded by the debate to discuss the national health service. I know from my postbag that the state of the NHS continues to be one of the key issues for the public. People have written to me from all parts of the country—no doubt they have done to other hon. and right hon. Members—expressing their concern at the closure of beds, wards and hospitals.
One of the reasons for that state of affairs is surely the NHS's increasing bureaucracy and the seemingly endless stories of waste. I do not say that that is the only cause, but it is one. The Government claim to be opposed to a vast and bloated bureaucracy, but the whole nature of the changes that the Government have introduced meant that an increase in bureaucrats and managers was inevitable.
If one separates purchaser and provider functions, each with their own management structures, one inevitably creates more management posts. If one establishes a contractual relationship between purchasers and providers, one inevitably creates a new layer of bureaucrats dealing with negotiations and contracts.
The Government make great claims for their reforms, trumpteting the fact that many more patients are now being treated. However, there is considerable doubt about how meaningful those figures are. The figures that the Government provide are for "finished consultant episodes", but it has been shown that the treatment of an individual patient for a single illness can lead to several "finished consultant episodes".
A leading health economist, Professor Alan Maynard, stated in a recent article in the Health Service Journal:
effects of the reforms are unknown due to the Government's
decision not to evaluate them.
That is presumably on the ground that the Government cannot possibly be wrong. There are, however, numerous examples showing that they do appear to be wrong when it comes to running the NHS. Millions of pounds have been spent by health authorities in hiring head-hunting firms for senior managers—£10 million was wasted on business consultants by the West Midlands regional health authority, as has been mentioned in the debate; £40 million was spent by the Department in setting up the NHS trusts, with no independent means of checking where the money has gone.
We have all heard of the loss of up to £63 million by Wessex regional health authority in its mismanaged computer scheme. Another example is the £100 million wasted by the NHS Supplies Authority through inefficient management techniques and muddled contracts. The catalogue goes on and on and on. It is no wonder that a "good news unit" has been set up by the NHS Management Executive in Leeds—it is more correctly titled the corporate affairs intelligence unit. Surely that is another example of waste and pointless bureaucracy.
It would be wrong to say that the Government have not responded in a more concrete way to the reports of waste and failure in the NHS. Following the Public Accounts Committee report on West Midlands health authority, the Minister made it clear that Sir Duncan Nichol was developing guidance addressing the need
to reinforce core public service values in the NHS.
That is quite laudable, one might think, but why does a task force have to be set up to reinforce public service values in what is supposed to be our greatest public service? My party would put the concept of public service at the heart of the NHS.
Our local hospitals should be accountable to the local people whom they are supposed to serve. The Government claim that they want to encourage the involvement of local people in decisions about health care provision for their area, but surely the creation of trust hospitals in their present form makes that more difficult. There is no effective local representation, with no real local accountability. Mind you, district health authorities are not really accountable, either. We need direct elections; only then will we get proper accountability.
At the regional tier, while no one wants to see a bloated bureaucracy, an open form of regional planning and supervision would be far preferable to the closed and secretive system that the Government propose.
In the long term, we should also like to see merged district health authorities and social services departments, to reduce unnecessary bureaucracy, to ensure a seamless provision of care and to reinforce local accountability. The Government have failed to set up ways of evaluating the effectiveness of their changes and thereby establish mechanisms to put a check on wasteful expenditure and growing bureaucracy. However, others have been doing it for them.
A recent key report from the British Medical Association underlined the fact that one of the damaging effects of the Government's changes has been to create a two-tier NHS. As a result of the so-called fast tracking procedure, patients of GP fundholders are receiving treatment ahead of patients whose services are purchased by the district health authority.
Such queue-jumping is happening even when district health authority contracts have not been fulfilled. That process is clearly undermining one of the fundamental principles of the NHS—that patients should be treated on the basis of need. Just because they happen to be patients of a particular doctor, people who are less seriously ill should not be able to jump ahead of people who are in greater need of treatment.
Much has been made recently of the increase in NHS bureaucracy, and the ever-increasing burden that pay and perks are loading on NHS finances. While nurses have to stick to 1·5 per cent. on average, trust chief executives are getting huge increases of 9 per cent. That is hardly fair.
What, therefore, is the future for the key workers in the NHS—the doctors and nurses who provide the care, and the many support workers? The Government have come out in favour of the Calman report on specialist medical training, and I am pleased about that. Where, however, are the resources to enable an increase to be made in the number of consultants? I shall be grateful if the Minister will answer when he replies.
The Government are committed to action to reduce junior doctors' hours, which is another thing for which I am grateful, but another report from the BMA recently pointed out that that is being patchily implemented.
The position of nursing in the NHS looks even worse. The number to be trained will fall by 16 per cent. In England between 1993–94 and 1994–95. That is despite research by the NHS management executive that shows that better qualified and trained nurses are more cost-effective and provide higher quality care. Clearly, the decline in the number of trainee nurses will have a dramatic impact on the future quality of patient care.
Surely the purpose of the Government's changes, although I do not know what was in their minds, was to try to use the money in the NHS as effectively as possible, but the reverse seems to be the case. Or is it that, by some unfortunate chance, the changes have highlighted the one problem that the Government have tried to mask—underfunding?
Of course, the Minister will try to blind us with statistics, and it is difficult to believe that over £20 billion is not enough. I agree with that, but we should remember that we spend less money on our health care as a percentage of GDP than almost every other major western country. In the light of that statistic, it is amazing that the NHS is as good as it is. For that, we must thank the dedicated people who staff the NHS at every level.

Mr. Day: The hon. Lady mentioned the total amount spent in this country. Is she aware that, in terms of public expenditure, this country leads Europe? In the rest of Europe, the figures for total spending as a percentage of GDP are different, because there is more personal input on health in other countries. That is not an argument for or against private health, but the hon. Lady must recognise that fact.

Ms Lynne: I recognise that more money has been spent on the health service, but it needs even more. Inflation in the health service is running at 3·9 per cent., so the money currently invested in it is not enough. The hon. Gentleman will be pleased to know that I am just about to discuss funding possibilities.
The Government should give careful consideration to the possible advantages to be gained from hypothecated taxation. It is often said that the British public want better public services, but are not prepared to pay for them. Perhaps that is because they do not trust us, the politicians, enough to handle their money. The catalogue of waste outlined today certainly gives them good cause to believe that.
We want a health service that is not plagued by ever-lengthening waiting lists. It is possible to manage other European health services to avoid such delays, so why not here? Perhaps if we politicians gave a commitment to spend resources and source revenue on specific health services, we might be able to convince the British people that we are committed to improving the services that they cherish. They might then believe that we can be trusted not to waste their money elsewhere.

Dr. Mawhinney: I want to be quite sure about what the hon. Lady is telling the House, because hypothecation would not, of itself, offer more money to the health service. Is she suggesting that the Liberal Democrats want to take more public expenditure from some other programme—and if so, which one—to give to health? Or is she


announcing to the House and the country that after the Liberal Democrats have increased taxation to fund education, they will increase taxation even further to pay for greater spending on the health service?

Ms Lynne: I am glad to answer that question.
The Liberal Democrats have begun to study hypothecation in detail and I sincerely hope that the Government will do the same. We could explicitly earmark the money raised from tobacco and alcohol exise duties for spending on the health service. We could raise considerable amounts through those duties from hon. Members alone.
It is not for politicians alone to decide on the appropriate way forward. We must open up the debate on how to fund our health services.

Dr. Mawhinney: I am grateful to the hon. Lady for giving way once again, because I am genuinely trying to understand what it is she has suggested. She answered my question by telling us a little bit about hypothecation. That was fascinating, but it did not answer my question.
Is the hon. Lady suggesting that money should be taken from other spending programmes to pay for the health service? The money raised through taxation on alcohol and tobacco is already spent. She cannot spend it twice. Is she announcing to the country that after increasing tax to fund education, she would increase it still further to fund the health service?

Ms Lynne: I am grateful for that further intervention. My party is looking at hypothecation. I am not making a commitment that the Liberal Democrats would raise taxes after the next general election. I want the merits of hypothecation of taxes to be. subject to public consultation. I want to go out and talk to the public about whether that is the best way forward. Our policy is markedly different from that of the Government, who brought in their reforms without consulting enough. Hypothecation could be the way forward and it is up to the Minister to examine all its implications carefully instead of trying to make a party political issue.
The British public must be given the opportunity to participate in the key decisions about the future, as well as being given the chance to hold to account those who made mistakes in the past.
I welcome the Secretary of State's announcement to consider having a debate in the House, for which I asked, on the new and possible treatment and use of eggs from dead foetuses for in vitro fertilisation. I am grateful to the right hon. Lady and I hope that she will honour that commitment.

Mr. Ray Whitney: I am afraid that the hon. Member for Rochdale (Ms Lynne) followed Opposition Members, as the Liberals usually do, by offering the usual carping, negative criticism of the health service. I congratulate her, however, because, in clear distinction from the Labour party, she at least provided one or two elements of possible Liberal Democratic policy. I do not believe that they bear too much scrutiny. The hon. Lady said, "We are looking at hypothecation," which is a pretty good example of how the Liberals approach policy making. I wish that she had offered a more concrete definition of her party's policy.
Everyone should join Conservative Members in applauding the idea that decisions on health should be taken locally. That was the thrust of the health reforms and it is one reason why they are working so well. The Liberal Democrats' proposition that such decisions should be made on the basis of elected local agencies, which would, however, be funded centrally, fills me with the deepest misgiving.
The problems faced by all central Governments over the funding of local authorities would be a picnic compared with the battles and feuding that would arise over health authorities being elected locally but funded centrally, whether that funding was derived from hypothecated additional taxation or additional income tax.
I hope that the Liberal Democrats will continue to explore such ideas, but will offer the nation a more informed analysis of their potential, because I genuinely believe that it is right that such ideas should be considered. That is why it was so sad to witness the performance of the hon. Member for Sheffield, Brightside (Mr. Blunkett) and that of other Opposition Members, because, as usual, they offered no positive thinking on policy.
One of the great tragedies of the Opposition is that they fail to understand that the provision of truly adequate health services for the 1990s is an international challenge facing all modern societies. These days, the aspirations of people, the challenges and costs of modern developments in medicine require the solution of terrifically difficult problems. Germany, France, the United States and other countries face that difficulty and they have all produced different solutions.
I believe that the British solution, as it is developing, is one of which we should be proud. Our solution is not perfect, but we will make no progress as a nation if the continued examination of this crucial subject is bedevilled by the mean-minded, ill-informed, pettifogging attitude adopted by the Labour party.
When the hon. Member for Brightside, the Labour party spokesman on health, can offer as the subject of his major speech nothing but a reference to the restaurant at which my right hon. Friend the Secretary of State for Health dines, it is a pure and appalling reflection on the paucity and poverty of what passes for thinking on the Opposition Benches. Such behaviour by the Labour party is traditional and it makes me somewhat hot under the collar.
The hon. Member for Brightside talked about the NHS and said, "We created it." Is the hon. Gentleman suggesting that "we", the Labour party, created the NHS? Does he know nothing about history? Has he any idea of the thought and work undertaken by others towards the creation of the NHS during the 1920s, 1930s and 1940s? He is totally ignorant. He obviously has no idea of the efforts made by all parties towards its creation. It started with the Liberal party and Lloyd George, and the idea was carried forward by Neville Chamberlain. The White Paper that provided the fundamental basis for the NHS was introduced by Henry Willink, the Conservative Minister for health in the wartime coalition Government. The irony is that the only significant change made by Mr. Aneurin Bevan was to go against the declared policy of the Labour party for locally based and controlled health units and opt for a nationalised hospital service. It is the nationalised hospital service which has caused so many problems over the 40 years. [Laughter]
What is the hon. Member for Bristol, South (Ms Primarolo) laughing about? Does she think that there were


no problems when Baroness Castle was Secretary of State and Lord Owen was Minister responsible for Health? There were huge problems, which is why we have had to find a way forward and why the health service reforms are providing an excellent solution to that challenge.

Ms Dawn Primarolo: indicated dissent.

Mr. Whitney: The hon. Lady shakes her head. She probably was not born at the time, but Herbert Morrison pointed that out to Aneurin Bevan, who won the argument in Cabinet but lost it in the succeeding 40 years.

Mr. Dennis Turner: Although that is interesting and I am grateful for the history lesson, I am not sure whether I accept the hon. Gentleman's interpretation of the historic events that led to the creation of the national health service.
We are all concerned about the national health service and should be thankful for every person who is treated in our hospitals. Last week, the Wolverhampton Express and Star announced:
Hospital Waiting Lists Are Soaring".
It said that 1,800 extra people were on the waiting list and that more than 6,000 were waiting. In the west midlands, more than 100,000 people were waiting for treatment. Is that success in the health service?

Mr. Deputy Speaker: Order. That was a very lengthy intervention.

Mr. Whitney: I clearly made a mistake. I could give the hon. Gentleman several answers, but shall give him a brief one. Since 1988, the average waiting time for treatment has fallen from nine to five months. I invite the hon. Gentleman to write to me and tell me what waiting times were in Wolverhampton in 1977 or 1978 during the last Labour Government, when the national health service was plagued by strikes.
I am glad that the hon. Gentleman accepts the history lecture and I hope that he passes it on to his colleagues in the Labour party. I hope that next time they have a debate on the national health service, they will not just say, as the hon. Member for Sheffield, Brightside said, "We shall clarify our own policies in our own good time." That good time is up. The nation demands to know what the Labour party has to offer.
The Conservative party knows that it has to offer the huge improvements which my right hon. Friend the Secretary of State for Health has outlined. The nation knows that we are now treating a million more patients than last year, and 3 million more than when we came into office. The nation knows that waiting times are reduced, there are tens of thousands more nurses and thousands more doctors, and their pay has risen by some 40 per cent. in real terms. We are proud of that record. The nation cannot be proud of a political party that claims, on bogus grounds, that it is its health service, but has no contribution to make to its continued development.

Mr. Terry Davis: The hon. Member for Wycombe (Mr. Whitney) tried to suggest that the Labour party had claimed that there were no problems before the Conservative Government were elected. That is nonsense.

Mr. Whitney: I said nothing of the sort.

Mr. Davis: Oh yes, he did. Of course, there were problems before the Conservative Government were elected and problems still exist in the national health service. The charge against this Government is that they have made the problems worse.
That charge is contained in the motion. I was interested to note that, in his peroration, the hon. Member for Wycombe never referred to the motion. I sha!1 debate the motion before the House. As I was coming to the House today I wondered how the Secretary of State for Health could oppose a motion that deplores the lack of accountability, growth in bureaucracy, and waste of resources in the national health service, all at the expense of patient care. After all, in the past year the Public Accounts Committee has produced two major reports on how resources have been wasted in the national health service. Both reports drew attention to the lack of accountability in the health service and pointed out that bureaucracy in the health service has failed the people of this country.The Committee says that all that has been done at the expense of patient care.
The West Midlands regional health authority has wasted millions of pounds. The regional health authority admits that it wasted at least £10 million. We have had a report on the Wessex regional health authority, which wasted tens of millions of pounds. The regional health authority and national health service management executive admit that it wasted at least £20 million. Today, the Secretary of State for Health said that the books were no longer closed and no longer examined behind closed doors. That is simply untrue. The books are examined behind closed doors by the district audit service, whose reports are kept secret.
If someone writes to the district auditor and asks about the reports, he or she is referred to,the regional health authority. If one then asks, "But how can I ask the regional health authority for the report if I do not know what was reported on?", he simply says that that is a good question. One cannot ask for a report unless one knows that it exists. If one knows that it exists and asks the regional health authority about it, one is most unlikely to get a copy of it because the books are examined behind closed doors and kept secret.
The internal report on the West Midlands regional health authority, known as the Carver report, explained how procedures had been flouted and regulations ignored and how people had wasted money. It was kept secret until someone in the regional health authority leaked it to a journalist on the Wolverhampton Express and Star. Only once it had been leaked and had come into the possession of hon. Members and referred to the Comptroller and Auditor General could the National Audit Office mount an investigation.
We should not depend on leaks. Reports should be put before us so that we can make up our minds on the basis of facts. I am not surprised that the Secretary of State has left the Chamber, having refused to allow me to intervene in her speech. She knows that what she said was totally misleading—I choose my words carefully to stay in order.
The West Midlands regional health authority was described by the chief executive of the National Health Service Management Executive as "a shambles". That is


the truth about the national health service 15 years after the Government were first elected. The Public Accounts Committee said that officers' behaviour
fell well short of the standards of conduct expected from public officials".
It said that not only were there
serious failings at all levels of management
in the West Midlands regional health authority, but a
serious failure by Members of the regional health authority and in particular the chairman, in their duty to ensure the accountability of regional management".
The report on Wessex said, most revealingly, that the auditors had sent their reports to the national health service management executive before the issue ever came to the Public Accounts Committee and before the National Audit Office was put on to it by people like my hon. Friend the Member for Southampton, Itchen (Mr. Denham). The auditors did not stop there, but sent the reports to the Secretary of State—not once but over several years. And nothing happened. That is where we come to the whole point of accountability.
When Sir Duncan Nichol, chief executive of the national health service management executive, came before the Public Accounts Committee, he had to say that he had no authority. I am not sure what he was the executive of, but he was called the chief executive and he had to say that he had no authority—it was a matter for the Secretary of State.
We are entitled to ask what the Secretary of State did. The answer can be given in one word—nothing. She did nothing about the fact that those appointed, particularly the chairman of the Wessex regional health authority, Sir Robin Buchanan, were personally responsible for that region's failures. Tens of millions of pounds were wasted at the expense of the care of those living in the region.

Mr. Nicholas Winterton: As the hon. Gentleman will know, I have taken a great interest in the health service over many years. Did the hon. Gentleman tell the House the truth when he said that Sir Duncan Nichol said that he had no authority over that matter? My understanding of the National Health Service Management Executive was that it administered the service on behalf of the Department of Health. If Sir Duncan Nichol has no authority, what is the point of the executive?

Mr. Davis: The hon. Gentleman might well ask. I can assure him that I have given an accurate summary of the statements of Sir Duncan and his predecessor. If the hon. Gentleman wishes to come with me after the debate, we can sit in the Library together and go through, not one or two, but several sittings of the Public Accounts Committee. He will then see that such statements were made, not only by one but by a succession of accounting officers from the health service management executive.
When the chairman of the West Midlands regional health authority eventually resigned, he received a letter of praise from the Secretary of State for Health and a golden handshake worth several thousands of pounds. I suppose that we should consider ourselves lucky because the chairman of Wessex regional health authority was promoted. If someone wastes more—tens of millions of pounds—he is promoted to a better job. That is the truth about accountability and the lack of accountability in the health service under this Government.
All this waste is at the expense of patient care. I shall give an example from the west midlands. A hospital in Birmingham that serves my constituency used to be called

the East Birmingham hospital. When it opted out and became a trust it changed its name to Birmingham Heartlands hospital—it is known locally by my constituents as the "Heartless" hospital. In October there was a series of newspaper reports about people attending the accident and emergency unit and having to lie on trolleys all night. Another group of people had to wait on trolleys the following night, and the same thing happened the night after that. Patients had to be resuscitated in corridors because there were trolleys in the resuscitation room. Patients had to urinate into bottles in front of other people in corridors.
Staff were almost driven to breakdowns in the accident and emergency unit because there were not enough beds for patients to be admitted. Those who could not be admitted were not attending the unit unnecessarily. They had been taken there by ambulance and examined by doctors who had decided that they should be admitted. But there were not enough beds.
My hon. Friends and I went to see the chairman of the district health authority to discover what he was doing as a purchaser. I did not agree with the Government's changes and voted against them, but the system was implemented. When we met the so-called purchaser to discover what he was doing to purchase an adequate accident and emergency service on our behalf, he told us that he could not obtain answers to his questions.
The chairman said that inherent in the Government's organisation was an adversarial—his word—relationship between his health authority and the trust hospital. That was said by a man appointed chairman of a district health authority by the Government. He has since been appointed as a chairman of a trust elsewhere. He also said that the position was aggravated by personality, but I do not want to become involved in personalities in the House. The adversarial relationship between hospitals and health authorities lies at the root of the problem.

Dr. Tony Wright: Does not my hon. Friend's illustration reveal the heart of the problem—that nobody is responsible for anything any more? We write to purchasers, providers and Ministers, but they all say, "It's not us, guy, it's somebody else." I have a letter from a Minister to back up my hon. Friend's argument. Mid-Staffordshire health authority lost £3 million in the market system last year. I asked the Minister to assure me that there would be no impact on patient care. I received a letter from him assuring me that patient care would not be affected, but this week the authority has closed four wards. It seems that nobody is responsible for that.

Mr. Davis: My hon. Friend is right: nobody accepts responsibility—it is always the fault of someone else in the national health service, particularly those who sit on the boards of health authorities.
One would have expected something to have been done about the lack of beds in Heartlands hospital last October. In the intervening three months there have been several circulars, meetings and discussions with Ministers, and the Secretary of State for Health has popped in and out of Birmingham. However, after she had made her visit, the problem recurred.
A fortnight ago the Birmingham Evening Mail featured a patient who had lain on a trolley for 21 hours. He was admitted at 5 o'clock and was not found a bed until 2 pm the next day.
My hon. Friends and I had a meeting with a junior Minister in the Department of Health. He seemed to know all about it and to be well briefed until we asked how many people had suffered the same experience and whether it was a lone incident. We asked whether that man was the only victim of what the Minister described as a sudden surge in emergency admissions. The Minister said no. He said that the man was one of 22 patients who had spent all night on trolleys at the same hospital where, three months earlier, patients had had to suffer the same experience for three nights in succession.
Let us examine the figures of the so-called sudden surge. We were unable to obtain good figures. The junior Minister gave one set of figures and the chairman of the hospital trust gave a different one—the two sets could not be reconciled. The junior Minister said that he would reconcile the figures, but we are still waiting for clarification. After we had talked to doctors, it was clear to us that there has been a steady upward trend in emergency admissions, not merely for one year on year, but year after year. That was true, not only in east Birmingham, but throughout Birmingham.
Those running the health service failed to predict what was an obvious trend. They actually thought that there might be fewer admissions this year than last. They had no explanation for reaching that bizarre conclusion, impossible hypothesis and incredible assumption—they failed and simply did not provide enough beds. That lack of beds existed even without the closure of the Birmingham General hospital, which has led to many more patients being admitted to the Heartlands hospital. Those running the health service did not even take that fact properly into account.
The problem does not stop with patients lying on trolleys instead of beds. Patients are taken out of bed and sent to other hospitals. They are discharged too early. Doctors making their rounds during the night may have to decide that, even though the consultant responsible for the patient stated that he was not ready to be discharged, the patient must be discharged because a patient who is in a worse condition is lying on a trolley.
Other patients do not receive operations as a result of the Secretary of State's gimmicks and gestures. Every hon. Member could recite from letters, cite examples and talk about families at their advice bureaux who have been unable to get the operations that they need. For me, the problem was crystallised in a letter written by a consultant at the Heartlands hospital in reply to a protest about the delay in an operation. The consultant wrote back stating:
There is no doubt in my mind that he requires the operation to correct his nose … Unfortunately I am only too well aware of the non-medical urgent priorities of many of our cases on our far too long waiting list. Nevertheless at this time the major incentive for surgery appears to be a management decision"—
not a medical decision, appraisal or assessment—
to remove all those who have been waiting more than one year for their operation regardless of priority and this has upset our general ability to bring forward cases".
That policy is being implemented in hospitals in order to achieve the Secretary of State's target whereby nobody has to wait for more than a year. It means that people who

need urgent operations are not having them. It is a scandal that people who should have operations—people whose noses bleed every night—cannot get an operation. The priority is decided by management, so that even those who are not so seriously ill will not have to wait for more than 12 months. Of course, we do not want people to wait for more than 12 months, which is a scandalously long time, but the waiting time should be reduced for everyone, not at the expense of the most urgent cases.
One might think that after what I have described—my hon. Friends from Birmingham could give similar accounts—everybody would realise that the fact that there are not enough beds lies at the root of the problem. It is not the staff or the doctors; it is the beds that people who should go into hospital, or must stay in hospital, cannot have because so many beds and wards have been closed.
We are told that things take less time now and that people do not spend so long in hospital. So putting to one side the mistakes that have occurred in the past 15 years, against the background of a crisis, what does the West Midlands regional health authority want to do in Birmingham? It wants to reduce the number of beds not by 10, 20 or 100, but by 1,500. It proposes 300 fewer beds in the very hospital where people have been left on trolleys all night. The fact is that the regional health authority does not know how many beds are needed.
Today I have managed to get hold of another report by the district audit service. Perhaps my hon. Friends have not yet seen it. The district auditor wrote:
hospital management in the west midlands have not determined the numbers of acute medical beds required for their contractual work load":
So much for all that business about purchasers and providers. The purchasers place contracts, but the providers do not work out how many beds they need, so people are lying on trolleys.
The Secretary of State praised the efforts of the staff in the national health service. At least we can agree on that, but the staff working in the national health service deserve our credit and our sympathy as they combat and struggle with the consequences of Government policies and the incompetence and waste of resources by Government appointees. It is not surprising that almost every day staff from local hospitals phone my local office to tell us what is happening there. They will not come forward; they are frightened because they know what will happen—they will lose their jobs; and, as 15 to 18 per cent. of the local people are already unemployed, they cannot stand up for themselves and we have to explain it for them.
The Secretary of State ignored the terms of the motion because she ignores the facts and does not live in the real world. She has lost the respect of the staff in the national health service and the confidence of all the patients.

Dame Jill Knight: That was good knockabout stuff, but now we come to some facts instead of flying off on extraordinary tacks. Listening to the speech of the hon. Member for Birmingham, Hodge Hill (Mr. Davies), one would think that nobody was ever treated in the health service or went on anything else but trolleys and never went into beds.
Whether the hon. Gentleman likes it nor not, and I suspect he does not, there has never been so much careful treatment of sick people in the west midlands and the rest of the country as there is today. People are being operated


on with infinitely more complicated techniques and treated with very much newer and cleverer treatments than ever before. They are being treated with drugs which were invented only a few years ago.
The hon. Gentleman and the Opposition should recognise that there is a great deal for which to be thankful in the way in which our health service is treating and curing people who, only a few years ago, would have died.
My right hon. Friend the Secretary of State made it absolutely clear that she deplored people lying on trolleys and was anxious to deal with the shortages as soon as she possibly could.
Never before has so much money been spent on the health service—more than £100 million a day. It is interesting that while Opposition Members are happy to object, to fulminate and frighten people into fits, they will never say how much more money they want spent on the health service, nor where they would get it.
No one has done more to tackle waste in the health service than my right hon. Friend and one of her predecessors, my right hon. and learned Friend the Chancellor of the Exchequer.
Previously, money was shovelled in increasing amounts into the ever-open maw of the NHS. No one knew how much was wasted because no one knew what anything cost. No one was ever able to assess one hospital's running costs against another's, or one doctor's practice against the one up the road to see if one was managed more sensibly and cutting out waste rather better than the other. No one ever questioned whether any drug costing less might be just as effective as one costing more, or whether wards, operating theatres or kitchens could be run better.
Mainly because it is essential that all the billions of pounds of taxpayers' money spent on the health service should go to patient care and not be wasted, the Government set about changing all that. However, the Opposition fought us long and hard on every single reform that we tried to make to ensure that waste was stopped. That is why they have a brass neck, a bare-faced cheek and a confounded nerve to table the motion on the Order Paper today. A great deal has been done which Labour would never have had the guts to do.
My right hon. Friend would probably be the first to agree that there is still some way to go. In fairness, eliminating all the faults in the biggest business in Europe takes a bit of doing.
May I suggest to my right hon. Friend that the first essential is accurate information. On that narrow point, I agree with the hon. Member for Hodge Hill. The proposed closure of the Royal Orthopaedic hospital in Birmingham, known locally as the Woodlands, is a case in point. I and others were given wrong and misleading information to support the closure decision. We were told that the hospital was losing £250,000 a year. Now there has been a Peat Marwick report. I am surprised that the hon. Gentleman, who said that he could never get any official reports from the auditors, had not heard of it.

Mr. Terry Davis: I made it very clear, as the hon. lady will see when she reads my speech in Hansard tomorrow, that I was referring to the district auditor's report. Peat Marwick is not the district auditor.

Dame Jill Knight: The hon. Gentleman, in dealing with audits and costs, never mentioned the most important audit report that Peat Marwick produced as a respected and independent auditor.

Mr. Richard Burden: Will the hon. Lady give way?

Dame Jill Knight: The hon. Gentleman must make his own speech. I am trying to be quick for the sake of other hon. Members.
I am anxious to inform the House and to say in front of my right hon. Friend that it was a very great shock to some of us that the information that we were given about the amount of money that the hospital was losing was not correct. Far from losing £250,000 pounds per annum, Peat Marwick says that it is making a profit of £680,000 per annum.
We were told that the supply of patients was drying up. Now we learn that there are waiting lists for that hospital. We were told that the layout of the Woodlands was too old fashioned and difficult to run. If that is so, why are so many doctors and surgeons virtually unanimous that the Woodlands should stay open and are campaigning hard to that end? We were told that the doctors and consultants did not object to a move. They most certainly did.
It is crucial that the information on which we make our decisions should be accurate and right; if it is not, we shall not reach the right decision.
I believe that the hospital should stay open and that is certainly the overwhelming view of the people of Birmingham right across the political spectrum. There is unanimous agreement in the council.
We now have a reprieve while the matter is considered again. I shall make two points to my right hon. Friend on it. First, please give us accurate and unbiased information. If there is a cost in the continuation of that hospital—it has been suggested that there is—please tell us what it is and what the option is. We can then decide whether we should pay that cost, whether it be with greater waiting lists elsewhere or with pure money.
Secondly, please can we reach a decision quickly? The Woodlands is peopled with highly expert staff. It has an international reputation. It is not surprising that all those people are under strong pressure to go elsewhere. They are saying to themselves, "Well, if the hospital is not going to be there, perhaps I should accept the request to go elsewhere." It is important not only that a right decision is made but that it is made soon, because we are losing staff through uncertainty.
The motion mentions bureaucracy. I know how open my right hon. Friend is to argument and persuasion, but there is some truth in the fact that bureaucracy exists. Some of it could be struck off. A doctor constituent of mine wrote to complain about a communication from the family health services authority. He says:
We have just received the enclosed communication from the Birmingham FHSA. The amount of work it will entail for our staff if one follows it to its logical conclusion which includes half-day absences for courses etc. is really quite pathetic and I wonder whether there is anything you can do to try and help us reduce this flood of bureaucratic waste".
I have the form here and it is indeed complicated. It would undoubtedly take a busy doctor a long time to fill it out. I gather from my constituent that it is new. Will my right hon. Friend be kind enough to investigate the complaint, because doctors do not have time to fill out forms that are not necessary?
I shall now deal with a concern that Birmingham FHSA has with the medical practices committee, which controls the distribution of general practitioners. The FHSAs are responsible for the smooth running 'of GP services in their area. The MPC is supposed to take the advice of the FHSAs, but it does not. I tell my right hon. Friend, with no pleasure, that there are too many running battles going on between the FHSAs and MPCs. Those battles waste time, impair efficiency and affect patient care.
Last summer, a GP in Birmingham, after two years of consistent inefficiencies, was disallowed from practising. That followed his suspension by the General Medical Council. On four occasions over two years, his conduct was officially deplored. On one occasion he was warned; on two others, £500 was withheld from his pay and he was suspended. On the last occasion, he was fined £1,000 and suspended again.
The FHSA wanted the GP out. Who can be surprised at that? It explained its need and responsibility to get proper care for the patients on its list. But the MPC did not agree. Oh dear me, no. It said that there would be eight months' suspension and told him that he would automatically be returned to the medical list after suspension, although the FHSA gave strong and unequivocal advice that the doctor could not or would not provide proper patient care and that it could not carry out its duty to give patients that proper care with that doctor still in place. For eight long months, there were no proper services, except temporary, for all the patients on his list. That matter is now resolved, but I have details of no fewer than five other cases where the advice of the FHSA has been ignored and overridden by the MPC. Will my right hon. Friend kindly look at that, because it needs to be checked?
Finally, I wish to voice my concern yet again about a system that keeps a consultant or hospital doctor in suspended animation for months, or even years, on full pay if he is under accusation of improper or negligent conduct. I would like to know what has been done to speed up the business of resolving that matter. I know of one case where a consultant was sent home. He did nothing for two and a half years, but was paid his full salary throughout that time. At the end he was found to be innocent, but it was a great waste of money. Of course I am not saying that he should be cut off from all his money when the case is not proven, but we need to speed up the arrangements formally made because it is a great cost to the country and a great strain on the doctor concerned.
My right hon. Friend has done much to improve the health service. She has fought successfully to get record sums from the Treasury. Even now, we hear that more will be allocated. She has tackled waste and inefficiency. She has stood up with courage and grace to the despicable attacks made by the Opposition and she has never shirked awkward decisions. How the Opposition would love to have a Virginia Bottomley on their side. It is not because she has done little, but that she has done so much and proved time and again that she is dedicated to constant improvement of the health services that I draw those matters to her attention and ask her to bring her considerable talents to bear on solving those problems.

Mrs. Alice Mahon: I welcome the debate on accountability, because somebody should certainly be held accountable for what is happening to the national health service. In spite of some of the rhetoric from the Government Benches, every day, in every part of the country, there is an acute bed crisis. Every day, people in pain, anxious, worried and afraid telephone some hospital early in the morning to find out whether there is a bed available. Increasingly, there is not, because one in three beds has been lost since 1979. Every day we read of sick people spending hours on hospital trolleys and mattresses, as my hon. Friend the Member for Islington, North (Mr. Corbyn) outlined earlier this week. We heard also from my hon. Friend the Member for Workington (Mr. Campbell-Savours), who has experience as a patient at Bart's hospital.
The Secretary of State says that she deplores the situation and wants to do something about it. She should be thoroughly ashamed of herself, because her so-called reforms have helped to bring it about. Every day we are bombarded with slick propaganda from the Department of health and the Government telling us that closing wards and hospitals will make the NHS deliver a better service. Fewer beds, but more patients treated, they claim.
A closer inspection suggests that the apparent increase in the treatment of patients has far more to do with the,introduction of the internal market and the increasing numbers of managers and administrators, who have the duty and the time to fiddle the figures and ensure that the statistics match what the Government want them to match. Before the internal market, putting a price on everybody's head was not a priority; treating the patients was.
We should keep saying again and again and outlining one or two of the tricks that the Government get up to, because finished consultant episodes mean that the same people can be counted if they change consultants two or three times. It is only one person, but he or she has been counted three times. The revolving door policy introduced in the 1980s, whereby elderly patients enter hospital for a fortnight and go out for a fortnight, means that the same people are counted over and over again on admission. I do not argue for elderly people to be kept in hospital any longer than is necessary.
The position regarding Government-appointed heads of trusts becomes worse the more that we read. A recent survey conducted by Incomes Data Services, a respectable industrial research body, said that the pay of trust chief executives had escalated sharply. It also found that, in stark contrast to the openness of the trusts, information on that was limited in detail and difficult to acquire. If such people are still working for the NHS, why cannot we be told what they are paying themselves? IDS concludes that public sector accountability appears to be diminishing. That is an understatement.
The Government refuse to keep statistics on the number of nurses and health workers who are disappearing as the army of administrators grows.

Mr. Garnier: Will the hon. Lady give way?

Mrs. Mahon: No, I will not. I am aware that many hon. Members want to speak, so I shall try to be brief.
Matters get worse. This morning, the Select Committee on Health, in its examination of the drugs budget, heard from witnesses, not for the first time, about the advisory


committee on national health service drugs—yet another Government quango. That particular quango is overseeing and advising on the limited list. We do not know its terms of reference; nor, it seems, does anyone else. Witnesses tell us that its terms of reference have changed from a scientific to a cost basis.
It was put to us that the committee is high-handed and secretive. It is obviously not transparent. We do not know whether the committee holds a statutory position, nor from where its advice comes or to whom it is accountable. The limited list system and the committee are so unaccountable that no one on the Select Committee or giving evidence to it knows how it works. This morning, a representative of the National Association of Health Authorities and Trusts claimed complete ignorance, so we are entitled to ask a question or two about that.
Our national health service, based upon equity and being free at the point of use, is disintegrating before our eyes.

Mr. Garnier: Will the hon. Lady give way on that point?

Mrs. Mahon: I am sorry, no. The hon. Gentleman can make his own speech.
According to a survey by the BMA, 42 per cent. of acute units in England give priority to the GP fundholding practices. Hospital waiting lists stand at over 1 million. We daily read of cuts, closures, queue jumping and sometimes, tragically, avoidable deaths. All the time, the huge unaccountable monster of a market-led NHS gobbles up precious resources.
My hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) gave an excellent exposé of what has been happening in the West Midlands and Wessex health authorities and the Government-appointed business men who have made such a mess and wasted so much money. The sleaze encouraged and permitted by the Government is a disgrace.
My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) referred to the increase in administrative costs. I wish that the Secretary of State had attempted to reply to some of the serious points that he made. When so much money is going on administration and being taken away from nurses, most people would accept that it is the patients, nurses and health workers who lose. In this brave new world of markets and managers, nursing and midwifery staff have decreased by 5·4 per cent.
Our ambulance service, once the pride and envy of the world, has also suffered. Since 1987, there has been a massive cut in staffing levels and the funding of the service has fallen by 10 per cent. in real terms. The Minister likes to talk in real terms. In 1992–93, 30 per cent. of England's ambulance services failed to meet minimum response times. In west Yorkshire, only 55 per cent. of responses were within eight minutes. In Halifax recently a young man tragically died. Because of cuts in the number of crews, a crew from another town had to come and the time that that took was unacceptable.
The new NHS executive management headquarters in Leeds cost £55 million, about the same amount that it would have cost to build the new hospital for which Halifax has been waiting since 1978. Last year, our trust submitted a plan for a new hospital at a cost of £50 million which was turned down by the Government. After meeting in secret, it has now submitted another plan costing

£35 million, thus hoping to save the Government £15 million in capital expenditure. That will mean the closure of two hospitals—the Royal Halifax infirmary and the Northowram hospital which caters for elderly and mentally ill patients. If that plan is accepted, the service to my constituents will be drastically reduced.
Calderdale has already seen its service much reduced. Due to overspending, infertility and cosmetic surgery are to be curtailed. Mixed wards have been introduced. I receive many letters of complaint about that, mainly from women who do not want to be on a mixed ward. Mixed wards have been introduced simply because managements have closed other wards. Women tell me that they feel at their lowest in hospital and are embarrassed to be on a mixed ward. They do not want them. But all the Government-appointed trust management says is that no one complains to it. They certainly complain to me and I would not want it.
The referral of non-GP fundholding patients from outside hospitals in Calderdale has been stopped and there has been an increasing use of short-term contracts. Staff have experienced insecurity, some of them working in casualty on short-term contracts. How does that relate to a Government who profess to care for nurses? In addition, we have seen the closure of one of our intensive care beds because of a £55,000 overspend. If the hon. Member for City of Chester (Mr. Brandreth) would donate just one quarter of the public money that he has had, we could reopen that bed and perhaps save someone's life.
The management of the trust is Government appointed and it is difficult to obtain any real information from it. The chief executive of the Calderdale health care trust wrote to me on 3 December in reply to a letter from me about the closure of the Arthur and Ada children's ward saying that the trust had no plans to close it. Such a statement was a disgrace from a public figure because a few weeks later she announced the closure of the whole hospital, not just the children's ward.
The new development plan for Calderdale is shortly to be put out for so-called consultation. The last consultations concerned whether we wanted trust status and just about everybody in the town said no. But a handful of people, appointed by the Government, decided to go ahead. Therefore, consultations in Calderdale and, I think, everywhere else, should be taken with a pinch of salt.
This week I received a letter from Calderdale and Kirklees local dental committee showing the cuts and how the figures are fiddled. Cuts in services are going on apace. The letter complains that the new purchasing authority, the West Yorkshire health authority, proposes to treat only the most severe orthodontic cases in hospital and to send the rest back to general practitioners. The health authority exists to provide services to my constituents, but in this case it is clear that it is under pressure from the NHS Management Executive to cut waiting lists. It accepts that it is under that pressure.
There is a shortage of orthodontists: the Select Committee was recently told in a report on dental services that the service in the United Kingdom was inadequate. That need will not go away. A group of patients in Calderdale are to be disfranchised just so that waiting lists can be shortened. Sadly, most of the patients involved will be children.
The letter states:
As in any medical or dental treatment, the most severe cases are the rarest and those children that fall into Grade 3 (moderate)


will be that group most referred for consultant treatment. The majority of these patients are children and it is probably that the treatment of these children is beyond the skill of most dentists.
The children concerned will disappear from the waiting list; they will go into the black hole into which the Government pour any statistics that cause them difficulty. Another service will be lost—but the waiting list will be shortened. It is all done by fiddling the figures.
The hon. Member for Birmingham, Edgbaston (Dame J. Knight) threw out the taunt that we wanted a Virginia Bottomley in our party. That is the last thing that we want—and, moreover, the last thing that the country wants is another Virginia Bottomley, or any more of the current one. I say that in the name of patients who, tomorrow morning, will be telephoning to ask for beds that are not there, or on a waiting list that is there.

Mr. John Whittingdale: Although I agree with nothing else that the hon. Member for Halifax (Mrs. Mahon) said in her speech, I join her in welcoming the debate. I believe that the issue of how to obtain the best possible management in the national health service is very important, and I am glad that the Opposition have given us the chance to discuss it. I regret, however, that Opposition Members who have spoken so far have chosen not to focus on that issue, or to set out any alternative policies.
Instead, the hon. Member for Sheffield, Brightside (Mr. Blunkett) treated us to a tirade of personal abuse, smear and innuendo, directed at those who work in the management of the health service and, in particular, at my right hon. Friend the Secretary of State. Although I have not been in the House for very long, I suspect that I shall have to wait some time before I hear such an outrageous speech again.
In contrast, I want to concentrate on the issue of NHS management. The NHS is one of the biggest employers in the world. About 800,000 people work for it—more than the total number working in the armed services, the police, the Post Office and British Telecom combined. This year, the NHS will spend £37 billion of taxpayers' money. Let me put that into proportion: the NHS budget is larger than the gross domestic product of New Zealand, Ireland, Egypt or Portugal. If we are to obtain the maximum value from that enormous sum, an organisation of such size, complexity and scope must clearly have good management.
The Opposition have given the impression today that NHS managers are simply unnecessary bureaucrats—that anyone who is not a doctor, a nurse or an ancillary is a worthless drain on resources. They seem to think that the sole concern of NHS managers is to obtain new offices and limousines: throughout the debate, they have delighted in denigrating the efforts of administrators.
It must be said that the Opposition are not alone in that regard. Every Saturday evening, those who watch "Casualty"—I do, regularly ; it is my wife's favourite programme—will note that the villain is the hospital manager. In every episode, he tells the medical team that they cannot afford to employ any more nurses, that they must close a few more beds or that they must lose a couple

more wards. The latest development is that the manager is to leave the hospital to work for the ultimate horror, a tobacco company.

Mr. Garnier: May I bring my hon. Friend back to the realms of real life, rather than the fiction presented by television? If he visits Leicestershire, he will see NHS trusts working side by side with non-trust systems. The three major acute NHS trust hospitals in Leicester are the Glenfield, the Leiester Royal infirmary and the Leicester general hospital. In those hospitals, and in the Fosse trust, my hon. Friend will see more patients being treated, shorter waiting lists, more medical staff doing more medical work, greater efficiency and better use of public money to provide the best possible service for NHS patients. Notwithstanding the picture painted by Opposition Members, the Leicestershire system deserves much praise.

Mr. Whittingdale: I entirely agree with my hon. Friend: the reality is very different. The position that he has described is duplicated throughout the country.
The truth is that NHS managers are as essential to the provision of health care as consultant surgeons. The introduction of proper management has not wasted money; it has saved money. According to one estimate, about £1·5 billion has been secured in efficiency savings since the reforms have installed proper management.
The Government's record in providing more resources for the NHS is second to none. Every year the increase in expenditure on the service has risen by more than that in almost every other area of Government spending. That record has allowed us to treat more patients each year, and to ensure that our standard of health care is among the best in the world.
However, it is no good simply increasing the budget every year if the way in which the money is spent is not properly controlled. The search for greater efficiency and value for money is also essential if we are to obtain the maximum amount of patient care. That requires first-class, experienced managers—and securing them means paying the proper rate for the job.
It also requires a clear, streamlined management structure. The original structure of the NHS was a recipe for chaos. Area health authorities, regional health authorities and health districts all competed with each other; the result was confusion, bureaucracy and a lack of accountability. In 1980, area health authorities were abolished, which removed one unnecessary tier of bureaucracy. The abolition of regional health authorities will remove another: it will give more power to the districts, which are closer to the people whom they serve, and it should also result in savings in administrative costs which can be ploughed back into patient care.
I hope that that will also mean that NHS resources can in future be distributed on a fairer and more equitable basis. I know that my right hon. Friend the Secretary of State is familiar with Essex Members' complaints about the way in which we have been penalised, year after year, by the weighted capitation formula used by North East Thames regional health authority. Indeed, we have suffered a double penalty.
The formula for allocating resources between regions works on the basis of capitation weighted on the basis of age and relative mortality; it does not take account of socio-economic factors such as housing conditions. The formula used within the North East Thames region to


distribute resources between districts has an additional weighting to benefit poorer areas. As a result, the region receives no more money because it covers some of the poorest London boroughs; but districts outside London lose as the regional distribution is skewed away from them.
North Essex—which covers my constituency—consistently receives less than its fair share. In 1991–92, for instance, revenue expenditure per head in North East Essex and Mid Essex was £317, compared with £345 in East Suffolk, a district which is identical to North Essex in almost every respect but which has the good fortune to fall within the East Anglia region. In view of the abolition of the regional health authorities, perhaps my right hon. Friend could introduce a single national formula for the allocation of resources to remove the unfairness.
When the regional health authorities are abolished, power and responsibility will rest with the districts. My constituency was previously covered by two district health authorities—the North-East Essex and the Mid-Essex health authorities. They have recently merged with a third authority to form a new single authority—the North Essex district authority. It has a budget of £277 million of which management costs are £3·4 million, or only 1·2 per cent. That is an extremely good record and one which compares well with private sector organisations.
The merger of the three authorities has not only strengthened the district's ability to obtain value for money in its purchasing but has produced a recurrent saving of £100,000. As a result of my right hon. Friend's recent announcement, it will have a further opportunity to merge with the family health service authority. It must make sense to have a single body locally which is responsible for the provision of every element of patient care. I welcome the discussions now taking place between the district health authority and the FHSA on the establishment of a single authority.
Strong and clear management is needed not only at district level and in the purchasing of health care; it is equally important in provision in hospitals. One of the great benefits of the NHS reforms has been that they have revealed the degree of inefficiency and waste which was endemic throughout the NHS. Prior to the reforms, it was often considered wrong even to think about the cost of treatments or, indeed, the cost of any element of the NHS. As a result, no effort was made to identify possible savings. Staff who faced the choice of using different procedures usually had no idea which might be the more expensive and which might be cheaper but just as effective. That has changed since the reforms.
Cost awareness is now widespread and practitioners have the information that allows them to take account of cost, not as the determing factor in deciding on a treatment but as a relevant consideration. At the same time, the requirement to assign costs to different procedures in different hospitals has shown enormous differentials in costs and, as a result, purchasers are now able to shop around and managers can compare costs and identify best practice. They are now able to obtain more value for money, which means that more resources are releaased and returned to patient care.
Strong management will keep down costs and ensure that more resources are devoted to patient care, but strong management is not enough to maximise efficiency. If anything has been proven in the past 14 years, it is that the greatest spur to efficiency is competition. Compulsory competitive tendering has already led to enormous savings

in the delivery of health care. Competitive tendering of laundry and portering services has already resulted in an estimated saving of £136 million. Other non-core activities could also benefit from private sector disciplines or CCT.
I cite just one example. Since the NHS Supplies Authority was established in 1991, it has brought together more than 70 separate local supply organisations. As a result, more than £60 million in purchasing costs has already been saved, but the scope for larger savings is considerable.
If the authority were able to take advantage of information technology, it could service every hospital in the country from a single warehouse connected to the hospitals by electronic data interchange. Companies such as Sainsbury, Unipart and National Freight operate complex delivery systems every day. The transfer of the Supplies Authority to the private sector would allow it access to necessary investment capital that it needs to set up such a system and the savings would allow more money to be put back into patient care.
It is not only in non-health activities that competition is providing greater efficiency and value for money. The NHS reforms have created an internal market that allows health purchasers a proper choice for the first time. General practitioners and district health authorities—

Mr. Turner: The hon. Gentleman believes that the health service reforms are wonderful, but my hon. Friend the Member for Wolverhampton, North-East (Mr. Purchase), who is sitting below the Gangway, has informed me that in Wolverhampton tonight dead people are lying in hospital beds because of the disappearance of the night portering service. Is that the image of the national health service in Britain in 1994? Dead people are not being taken from their beds until the following morning because of the failure to provide a portering service.

Mr. Whittingdale: I cannot answer for the service in Wolverhampton, but I accept that the NHS is not perfect and that we still need to make improvements. The Opposition, however, will not accept that more patients are being treated every year and that things are getting better. If the Opposition would recognise that, we might have a more constructive debate.
As I was saying, general practitioners and district health authorities are now able to seek competition between providers and are therefore able to obtain faster and cheaper treatment for their patients. The line between public and private care is now being blurred and NHS trust hospitals are trying to attract extra resources by providing private treatment. Purchasers are turning to private hospitals as well as to NHS hospitals.

Mr. Rhodri Morgan: Wonderful.

Mr. Whittingdale: It is wonderful, and I shall explain why. GP fundholders have been quick to take advantage of the freedom that they have as budget holders. One GP fundholder in my constituency has contracted with the local private hospital rather than the NHS trust hospital. with the result that 90 per cent. of his surgical referrals are: carried out by the private sector. In so doing, he has largely eliminated waiting lists, his patients are now treated in single rooms in comfortable surroundings and the cost to his budget and, therefore, to the NHS is less than if he had contracted with the local trust hospital.
The NHS reforms have not—

Sir Harold Walker: I have listened carefully to the hon. Gentleman. Will he give me a little advice on how to reply to a constituent who wrote to me yesterday? An elderly lady who is going progressively blind because of cataracts has been told that she will have to wait 62 weeks for an appointment for the consultant even to examine her. Will the hon. Gentleman tell me how I might best advise my constituent?

Mr. Whittingdale: I would advise the right hon. Gentleman to tell his constituent that waiting lists are declining and that the number of cataract operations being performed is increasing.

Mr. Hayes: Perhaps I might suggest that the constituent of the right hon. Member for Doncaster, Central (Sir H. Walker) uses the national health service hotline, which is a very effective means of dealing with the problem.

Mr. Whittingdale: I am grateful to my hon. Friend, and I am sure that the right hon. Gentleman will pass on that advice to his constituent.
The NHS reforms have not led to increased bureaucracy and waste as the Opposition motion claims. They have, in fact, done precisely the reverse. They have improved efficiency and they are enabling more patients to be treated. I hope that my right hon. Friend the Secretary of State will build on the reforms by encouraging more competition in the provision of health care and thus allow us to treat even more patients in future.

Mr. Deputy Speaker (Mr. Michael Morris): Madam Speaker has stated that between 7 pm and 9 pm speeches shall be restricted to 10 minutes.

Ms Tessa Jowell: There are two views of the condition of the national health service—the Secretary of State's and everyone else's. The Secretary of State seeks to assure us that all is well and, indeed, improving. Another reality is played out day and night in the casualty units of London's hospitals. Since before Christmas, I have made regular evening visits to a number of casualty departments in London to see at first hand the impact of bed closures and the internal market on Londoners' health service.
I shall at this point make a special mention of King's, which is the hospital that achieved notoriety this week and on a number of previous occasions because of the long waits on trolleys that patients have to endure before being admitted to the hospital. It is not unusual, but it is probably worse at King's than anywhere else in London. The reasons are obvious.
King's has closed 120 beds in the past two years. Is it, therefore, surprising that the hospital finds itself, night after night, without beds to which to admit sick patients? The only alternative is to leave them lined up on trolleys that touch one another, in the casualty department.

Mr. Ian McCartney: I hope that my hon. Friend will mention the Higgins inquiry report, which the Secretary of State promised to implement in full as a matter of urgency, into the accident and emergency service at King's, where people were lying for up to 24 hours and some people died before treatment was given to them. If the Higgins inquiry report was to be implemented it meant that an absolute commitment, and a fast track commitment, had been made to providing new resources. Is my hon. Friend saying that that promise is not being kept?

Ms Jowell: As the Secretary of State said earlier, building work is under way for a new accident and emergency department. Indeed, late last night I saw the new X-ray facilities at the hospital. However, it is pointless to tell sick people tonight that in two years' time there will be an accident and emergency department, which will mean that they do not have to wait on trolleys. The Conservative party patently refuses to understand that sense of desperate urgency.
The crisis in our hospitals in London has been brought about by two factors. The first factor is the steady closure of beds during the past five years—inner London has lost about 14,000 beds—and the second is the impact of the internal market. The market now means that hospitals have to live by the rules of competition. "Contractual viability", in new NHS-speak, means 100 per cent. bed occupancy. Anything less will put prices up and therefore threaten the market competitiveness of the hospital.
That also means that there is no slack to deal with the inevitable peaks and troughs in demand that are part of being a national health service hospital. While hospitals may be operating at the limits of the capacity that the contracts that their purchasers have paid for, they are all operating with closed beds, so they are in fact operating at below real capacity and only at the capacity which is specified by the market, not by the needs of patients on the waiting lists.
It is interesting to note the way in which the private sector, which the Government constantly hold up as a desirable role model for our national health service, has such a remarkable and unfair advantage over the national health service. There are important differences.
First, the private sector does not have to deal with emergencies, so all admissions are planned admissions. In contrast, almost every national health service hospital in London admits about 60 per cent. of patients through the accident and emergency department. They are unplanned, unpredictable, unquantifiable admissions—quite unlike the situation in the private sector.
The second difference between the national health service and the private sector is that the private sector responds only to demand. Therefore, if patient demand requires that operating theatres be fully used and consultants kept fully occupied operating, that is what they do. They are not bound by the absurdities of the internal market, which mean that a national health service which is desperately needed to operate at full capacity is prevented from doing so by Government edict through the internal market.
As one health manager said to me recently, it is now
dog eat dog in the national health service".
Consultants admit their elective patients needlessly early, simply to stop anyone else getting into the bed. As a result, patients who need to be admitted through the casualty department have to wait on trolleys because there are no beds available for them.
Some hospitals manage somehow. They put up camp beds. When a bed becomes free during the night it is only because another patient has died. The staff then work to "get the bed cold" in order to take a trolley patient up from the casualty department. However, the patient who is being admitted has to be admitted to the ward wherever the vacancy is. That is why elderly men are admitted to gynae wards and women with gynae complaints are admitted to wards where all the other patients are elderly men. As one


member of staff said to me, when one has to operate under that type of pressure the quality of care goes out of the window.
Let us dwell for a moment on the fact that the patients charter says that only after someone's operation has been cancelled twice is guaranteed admission within a month. The mayhem that the market has created in our hospitals means that that is regarded now as an acceptable standard.
We heard a lot from the Secretary of State about the way in which waiting times have decreased. What has happened, however, is that people are now treated on the basis of the length of time that they have been on the waiting list only, not on the basis of clinical need.
As a doctor told me a couple of days ago, if someone with an ingrowing toenail has been on the waiting list for 18 months, he will be taken into hospital because the patients charter requires it. However, a woman who needs a hysterectomy, who has been bleeding and in discomfort for many months, and has been on the waiting list for five months, is likely to have to wait 18 months before she is admitted. That type of perversity, that absurdity, is played out day by day in our national health service hospitals.
Is the Minister aware of the Norton scale? If he is not aware of the Norton scale, which was posted up in an accident and emergency department that I visited last night, let me tell him the way in which the administration of that new nursing protocol is described:
Due to increased waiting times in accident and emergency, it is essential that we assess our patients' risks of developing pressure sores.
That is a nursing protocol to ensure that people—often elderly people—who wait for hours on trolleys are monitored, because of the likelihood of their developing pressure sores and dehydration. It is now a fact of life that elderly people who are kept waiting in casualty departments arrive on the wards, when they are eventually admitted, in a worse state than when they arrived at the hospital.
There has also been a sharp increase in the numbers of people attending accident and emergency departments and, more disturbingly, in the numbers of people who are not registered with a general practitioner.

Dr. Charles Goodson-Wickes: It will be 50 years ago next month that a Conservative Minister in the wartime coalition published the first Bill promoting the national health service. My hon. Friend the Member for Wycombe (Mr. Whitney) rightly gave credit to Liberals such as Lloyd George and Beveridge, and to the Labour party for actually enacting the legislation, but every party in the House can take credit for the basis of the NHS.
Having listened to some of the Opposition's arguments tonight, I feel that they still fit the descriptions such as "the halt, the sick and the maimed" that we find in the Third Reading debate on the Act that established the national health service. I sometimes wonder whether the Opposition parties can really cope with the advances of the past 50 years.
The strength of the national health service has been much trumpeted over the years, but, not surprisingly, the weaknesses became ever more obvious. By the early 1980s, it was obvious to everybody that its management was inadequate. The Griffiths report began to tackle those problems. However, it was not until the Government under Lady Thatcher published the White Paper, "Working for

Patients", that the most radical changes were proposed. What a culture shock they were, and what emotions they aroused.
According to the Labour party, hospitals would opt out of the national health service, general practitioners would collapse under the administrative burdens of running their practices, and patients would suffer further as the whole system ground to a halt. Now, three years on, we can see the great success story of those Conservative reforms. The internal market works, based on the logical concept of separating health needs from the delivery of health care. Nobody pretends that there were no teething problems—you, Mr. Deputy Speaker, are in an especially good position to judge that. We all remember the irate meetings and the clamour riding on the back of the threat of change.
Having been trained in the national health service and having worked in it for much of my life, I have some insight into the fears. How were doctors expected to manage budgets when they had spent their entire professional lives ordering investigations and prescribing drugs with no knowledge of the costs involved, let alone any concept of accountability? Yet, surprisingly quickly, the first tentative steps towards fundholding became a rush. Now about 25 per cent. of the population are covered by fundholding GPs.
The story of national health service trusts is similar. The various waves almost had to be held back, as hospitals—their number is now almost 400—clamoured to regain some of the independence that they had lost over the years When they were kept down by arrogant and stifling bureaucracies. Doctors, nurses, ancillary staff and administrators have risen to the challenge. Suddenly, the national health service was competing with the independent hospital sector for contracts.
I declare an interest as a director of two private health care companies operating in this country, one British and one German. They cannot relish the process of NHS reform, but they now have an added stimulus to give choice and value for money.
I welcome the competition. The private sector will survive only if it offers a better service than the reinvigorated national health service. That is what Conservative competition is all about. I can live with that. It gives better treatment for patients, and that is the most satisfactory outcome of all. It so happens that neither I nor my family have private health insurance. We have all been in-patients in the NHS over the past few years and we all have a vested interest in it—and we have all had the most excellent treatment.
We see a great success story, but all we hear from the Opposition parties is negative vilification, with no acknowledgement of the progress that the Government have made. Even if the Labour party does not recognise the achievements of my right hon. Friend the Secretary of State, perhaps Labour Members should listen to Professor Le Grand of the Socialist Philosophy Group, who said that fundholding was
perhaps the biggest success story".
As my right hon. Friend told the House earlier, Professor Le Grand emphasised that
few who work in the NHS would want to go back to the old pre-reform system.
The Labour party sees efficiency as some sort of inhumane capitalist mechanism rather than as a means to deliver the best possible resources for the care of the only person who matters in the exercise, the patient.
I am ashamed to say that only two weeks ago my own trade union, the British Medical Association, published pleas for pilot projects. We have heard that expression before. "Pilot projects" were among the concepts advanced by the Labour party at the general election, and it said that the election would be the test of health care delivery in this country. We know the result of that election, and we know that pilot schemes have been translated into the real thing over the past three years, and that patients have benefited thereby.
In anticipation of today's debate, the hon. Member for Sheffield, Brightside (Mr. Blunkett) announced that 10,000 beds had been lost in one year. That statement is an index of the hon. Gentleman's crass ignorance as a health spokesman. Has he never heard of day surgery? Does he not realise that day surgery does not require beds, and that stays in national health service beds are getting shorter and shorter? Does he not realise that more and more patients are being treated in out-patient departments, and that fundholders now treat more patients in their own surgeries, so we need fewer beds?
The Opposition keep pushing the argument about people being left in corridors, and so on. That is not a medical problem; it is a management problem. We accept it as such and it will be sorted out as such.

Dame Jill Knight: Will my hon. Friend give way?

Dr. Goodson-Wickes: No, I regret that my speech is time-limited.
Let me educate the Labour party. In 1991–92, 36 per cent. of elective surgery was done on a day basis. That percentage has now risen to 45 per cent., and the Royal College of Surgeons has a target of 50 per cent. for the near future. Sadly, the hon. Member for Brightside seems to have no idea of the effects of community care on the need for beds.

Dr. Joe Hendron: Will the hon. Gentleman give way?

Dr. Goodson-Wickes: I cannot, I fear.
Community care has introduced a whole new and humane system that gives the lie to the accusation that the Government are centralist. It has produced the most major change in influence from central to local government, and the greatest increase in local responsiveness that we have seen for many years. That is another reason why fewer beds are needed in our hospitals.
My constituency is served by three excellent national health service trust hospitals, and I have reports from regular visits there. One of them, St. George's Healthcare, has reduced its running costs by almost £10 million, through a combination of removing overheads including direct management costs, improving clinical efficiency and income generation. There has been a vigorous competitive tendering programme, and the trust even generates its own electricity—I welcome that. At night, it sells electricity to the London electricity board, thus generating savings of about £900,000 per year. Who would have thought that that would be an outcome of Conservative policies? And how agreeable it is.
The St. Helier national health service trust has treated more patients every year within the patients charter guidelines, within its financial budget and within the

Department of Health programme for total quality management. The Kingston NHS trust has reduced its staff by 7 per cent. while productivity has increased by 23 per cent. There is multi-skilling of staff, and clinical staff are now released from administrative duties to do the job for which they were trained.
In summary, there is solid evidence that Conservative policies work. In 1948, Nye Bevan said:
The House of Commons only produces Bills, but it is the men and women outside who can make the living realities.
How ashamed he would have been if he had heard the Labour speeches today. They contain no policies whatever. I have the greatest confidence in my right hon. Friend the Secretary of State, and she is running the largest organisation in Europe—for the benefit of patients.

Mr. Richard Burden: On 8 January last year, Sir James Ackers resigned as chair of the West Midlands regional health authority. His resignation was greeted by a letter from the Secretary of State, who said today that, occasionally, things go wrong in the national health service. The letter she wrote to Sir James Ackers included the words: You have strongly supported the reforms of the NHS and have overseen their successful implementation in the region. In addition you recently initiated some important improvements in the managerial structure of the region. Underpinning all this has been your personal commitment to the health service and its patients.
Clearly, the Secretary of State thought that he had done a rather good job. One or two people disagree with her on that. The Public Accounts Select Committee disagrees with her, because its report into goings on inside the West Midlands regional health authority during Sir James's stewardship began with the following words:
The use of National Health Service funds by the West Midlands Regional Health Authority has been characterised by serious shortcomings in the management, control and accountability of the Authority's Regionally Managed Services Organisation. These shortcomings have led to the waste of at least £10 million.
The Committee looked at the engagement of a consultancy firm to consider the supplies organisation, which promised to save £50 million. It ended up costing the West Midlands regional health authority, and ultimately the patients in the west midlands, between £2·5 million and £4 million. There were no terms of reference or financial conditions in the arrangements established and the report of the Comptroller and Auditor General noted that the consultants' expenses amounted over one year to some £350,000, and included such items as leased houses, aircraft hire and lavish entertainment. Clearly, that was the kind of good job being done at the time.
Of course, many such projects were the brainchild of the former director of the regionally managed services department—a man who had a penchant for privatisation. Privatisation has been something of a theme of West Midlands regional health authority. One instance was the privatisation of the management services division, which was turned into a company called Qa Business Services, for £750,000. It went bust in 18 months and the consequences have so far cost the West Midlands regional health service £928,000.
The staff did not do too well from that privatisation. I find it interesting that Conservative Members have said that Opposition Members do not care about white-collar staff. I would like to know what they would say to former


employees of Qa Business Services, who lost their jobs. Many did not get redundancy payments and some lost up to two thirds of their pension entitlement because the pension fund that was set up could not cover its liabilities.
When I and other hon. Members have tried to raise the issue of the pensioners of Qa Business Services, we have been fobbed off time and again and after all the reports, the answer given was that the national health service had
no moral or legal responsibility
to those people. What a travesty and an insult. Even after that, Conservative Members have the gall to say that we do not care about white collar staff in the national health service.
Of course, others did rather better. Sir James Ackers, the man who was praised in the letter from the Secretary of State, received a pay-off of £10,000. That pay-off was not in his contract, but was a discretionary payment. The man who oversaw the consultancy to which I referred received a pay-off in excess of £80,000. There is a small problem with that, because it was subsequently discovered that he was overpaid by about £41,000. Attempts to recover that money are still going on.
The gentleman who authorised that overpayment was Mr. Mel Nock, who was in charge of the personnel function and has since left the regional authority. He has recently been appointed as the consultant to advise on personnel matters for the new North Birmingham health consortium by Malcolm Skilliorn, a colleague from the regional health authority and other places before.
That is the reality of the serial sleaze of the national health service today and the Secretary of State has the gall to say that things go wrong from time to time. Such things are endemic in the mentality that the Government have introduced into the NHS; a mentality of bureaucracy and unaccountability and an obsession with the market.
In my own district, South Birmingham, we have experienced the operation of that market. We were told that, under the market, money would follow the patients. I can tell the Minister that we have plenty of patients in South Birmingham, but we have a little difficulty getting hold of the money to treat them. The Royal Orthopaedic hospital, adjacent to my constituency of Northfield and internationally renowned for orthopaedic services, is currently under threat of closure because of the way in which the market is operating. The hospital runs at a surplus, yet it is still under threat of closure. It has been reprieved for a short time for consultation.
That is not all that is happening. One thousand five hundred acute hospital beds in Birmingham are under threat. Birmingham also has examples of patients waiting for up to 22 hours on trolleys. Elective work has virtually dried up in many hospitals because emergency patients are taking all the beds. The future of Selly Oak district general hospital is also under threat.
Perhaps Ministers will have an answer for that great beds crisis. They may suggest sharing beds. That always saves a little money. However, that is not much of an answer to patients in the south of Birmingham. That area is short of between £12 million and £16 million every year.
The massive organisational changes that have been brought about by the Government and the effects of their reforms were blamed in a report as contributory factors to a well publicised case over the summer of maldiagnosis of bone tumours, which meant that large numbers of patients may have been wrongly diagnosed.
One of the most insidious effects of the market is the way in which it sets hospital against hospital; purchaser against so-called provider. For instance, the Royal Orthopaedic hospital, to which I referred earlier, is in surplus but under threat of closure. Let us imagine that the health authority sees sense and reprieves that hospital, not in the short term, but in the longer term. The health authority would still be short of money. It would still have to close something, so it would perhaps consider the number of beds and would take some beds from Selly Oak district general hospital.
The health authority could decide that it should not cut beds, because the emergency beds were already overflowing. What could it do as a result? It would have to cut what is called its purchasing allocation and cut the services that could be provided by the very hospital that it had decided to keep open.
What would happen then? Local people would not be able to receive treatment at their local hospital, because the local health authority would not have the money to purchase the service. The hospital would have to raise income to pay for that service. How? An interesting scheme in Birmingham Heartlands hospital in east Birmingham over the summer determined that a sophisticated scanner, intended to treat patients, was used to treat pigs and sheep. It was hired to the Meat and Livestock Commission because it was described by the West Midlands regional health authority as a "form of income generation". That was one rather interesting scam.
A more likely outcome is that the hospital under threat would end up only treating patients from doctors who are GP fundholders or those who were able to pay for themselves through the private sector. It is a ridiculous merry-go-round on which a hospital is reprieved, but the health authority cannot buy services from that very hospital. That is the real effect of the market. That is what is happening in Birmingham and in other parts of the country.
In June, during health questions, I raised an incident in my constituency with the Secretary of State, which applied to that same orthopaedic hospital. A patient was told that he would have to wait six months for a knee operation, but that it would be only six weeks if he came from a GP fundholder. That is a distortion of the principles on which the national health service was founded. The sooner we get rid of the market mechanism, the better.

Mr. Jerry Hayes: I declare an interest. I advise the Western Provident Association, which, as most people know, is involved in health and is non-profit making.
This has been a particularly depressing debate. We heard from the hon. Member for Sheffield, Brightside (Mr. Blunkett) one of the most disgraceful speeches that I have ever heard from an Opposition spokesman in my 10 years in the House of Commons.

Mr. Jim Dowd: The hon. Gentleman always says that.

Mr. Hayes: I say that only when the hon. Member for Brightside speaks. He accused the Government of sleaze, yet he had the nerve to attack the Conservative Members' wives who served on health authorities. He criticised the number of appointments of Conservatives. He should mug


up on his history of the health service. There are slightly more Conservatives on health authorities because the hon. Gentleman's predecessor, the hon. Member for Livingston (Mr. Cook), forbade members of the Labour party to take such appointments. The hon. Member for Brightside cannot have it both ways. If air miles were given for sleaze, the hon. Member for Brightside would be the first man on Mars.
Talking of interplanetary activities, it is remarkable that no Opposition Member has had the grace to mention that far more people than ever before are being treated every year—more than 1 million people since the health service reforms came into operation.

Ms Jowell: Will the hon. Gentleman give way?

Mr. Hayes: We are constrained by time. I would be delighted to give way to the hon. Lady, but I am unable to do so.
We are now spending more than ever before—£100 million a day. Efficiency savings are being made. We are talking about 2 per cent. this year and, perhaps, 2·5 per cent. next year. An extra £450 million will be spent directly on patients. It will not go to the Treasury.
The other amazing thing that I could not believe was that the hon. Member for Brightside could not tell us what his policy is. That is one matter on which I profoundly disagree with my right hon. Friend the Secretary of State. She called the hon. Gentleman the mañana man because he was so slow. The word "mañana" in connection with the hon. Gentleman implies far too much urgency. However, he gave us a little clue. He said, "I will tell the House what the policy will be about. It has something to do with treating patients." Wow! I can imagine the great slogan when that policy document is produced in perhaps two or three years, after the next general election—"Something to do with treating patients."
The one thing that the hon. Gentleman did right was to introduce the debate on wasting resources and on bureaucracy. If anyone knows all about wasting resources and all about bureacuracy, it is the hon. Gentleman. Just a little clue about what would happen if he became Secretary of State for Health is what happened when he was the leader of Sheffield council. Under his leadership, the number of committees increased from 97 to 247. No Opposition Member had the grace to tell the House that, for every 100 patients treated before the reforms, there are 116 now.

Ms Primarolo: They are patient episodes.

Mr. Hayes: They are not patient episodes. With the greatest respect, the hon. Lady does not know what she is talking about. We are talking about the number of people being treated, and that is just in the short period since the reforms. Opposition Members should be proud of that. Anyone who works for the health service would feel nothing but despondency and misery at the dangerous nonsense that comes from the Labour party.
By April, national health service trusts will provide 90 per cent. of health and community care. Have they been a disaster? Opposition Members will say, "Of course they have." They have not, because trust activity has grown by 5·3 per cent. compared with an average of 4·3 per cent. in the other sector, and that growth is continuing.
When we have the great policy document from Opposition Members, what will they do? Will they abolish trusts, as they promised to do? The hon. Member for Bristol, South (Ms Primarolo), who will delight us with a speech a little later, is nodding her head. I can only assume that we now have a policy.
Let us have a few more. What about GP fundholding? Six thousand GPs have become fundholders. One in four of the population are covered by them and by April it will be one in three. What will the Labour party do about fundholders? They have been a manifest success. The British Medical Association is in favour of them, GPs are in favour of them and, clearly, patients are in favour of them. I am looking for an inclination of the hon. Lady's head—just a little clue, perhaps.

Ms Primarolo: rose—

Mr. Hayes: I will happily give way to the hon. Lady.

Ms Primarolo: The hon. Gentleman knows that the BMA has denounced the Government's two-tier health system, which was created by fundholders who allow patients to jump the queue, ahead of other people in greater need. The hon. Gentleman also knows—[Interruption.] The hon. Gentleman asked me a question: shall I sit down, or would he like me to answer it? He asked whether we are in favour of a two-tier system and GP fundholders. We have said before that we do not support GP fundholders. We believe that they are wrecking the national health service, as the Government intend, and they will not exist in this form.

Mr. Hayes: "In this form"—if ever there was the small print, that was it. Why does the hon. Lady not tell the House that, for every manager—[Interruption.] The hon. Lady is having a fascinating conversation with my hon. Friend the Member for Wyre (Mr. Mans), but perhaps she would like to listen to me, because she will hear even more exciting information.
For every manager in the national health service there are 26 doctors and nurses. Why do Opposition Members not say that? National health service managers in the over-bloated service that we are told about account for 2 per cent. of the national health service work force and 3 per cent. of the wages bill, and administrative and clerical managers account for 11 per cent. of the wages bill. The hon. Lady should be telling the country about those facts and figures. The proportion of national health service staff who provide care directly to patients increased from 60 per cent. in 1981 to 65 per cent. now. That trend will continue.
I will tell the House what the Government are doing about waste. There is bound to be waste in an organisation the size of the national health service. What are we doing to cut bureaucracy? We are allowing health authorities to merge—a perfectly sensible reform.

Mr. David Hinchliffe: Labour proposed it.

Mr. Hayes: The hon. Member for Wakefield (Mr. Hinchliffe) says that Labour proposed it. He should welcome what we are doing rather than attack the
Government.
Some years ago we abolished area health authorities, and now, thank heaven, we are abolishing regional health authorities. Why do Opposition Members not give us some good news? There is a lot of good news? Opposition Front-Bench Members should read the King's Fund


Institute report, and they should read about health care in London. The hon. Member for Dulwich (Ms Jowell) in particular should listen to what is happening in London.

Ms Jowell: I know what is happening in London.

Mr. Hayes: She says that she knows, but if the hon. Lady reads the latest issue of "London Monitor" she will see that it states:
For the first time in history, primary care will be tailored to meet the needs of all London's population, regardless of age, gender, socio-economic status and community origin.
That is good news. Opposition Members should read the views of Rosalind Wilkinson and Hilary Scott, who said that the City and East London family community health service organisation will be discussing exciting new developments in the provision of health services in the east end of London.
There is a lot of good news on the health service, and Conservative Members are sick to death of it being ignored.

Dr. Joe Hendron: Thank you, Mr. Deputy Speaker, for calling me.
I have listened carefully to the debate and to the speech of the hon. Member for Wimbledon (Dr. Goodson-Wickes). I have been involved in primary health care for 30 years in west Belfast, but I must be living in a different world from the hon. Member. The fact that most of the population in my constituency are from social class groups 4 and 5 may have something to do with it.
I find the attitude of Conservative Members incomprehensible. This is the 20th century and we are about to move into the 21st. We should expect health services to improve: they are improving in every western European country. Why have Conservative Members been crowing? One after another has shouted about all the fantastic things that are happening. Of course, improvements have been made. Perinatal mortality rates, which were higher in Northern Ireland than elsewhere, have come down. We expect better maternity and geriatric services and better care for handicapped children.
Why cannot Conservative Members accept objective criticism from the Opposition? Why is a debate like a boy scout game, with hon. Members trying to catch each other out on point after point? Genuine criticism has been made but does not seem to have been accepted. If Conservative Members were to point out that they had achieved A, B, C and D but were having problems in other sectors, they might have some credibility.
My experience of these matters has been in Northern Ireland and I make no apology for referring to it. I pay tribute to the outstanding hospital staff of Northern Ireland, especially those in Belfast, where there is the violence factor, which I need not touch on now. Staff at the Royal group of hospitals—not just doctors and nurses but right across the board—deserve our appreciation. I should especially like to mention ambulance drivers. Throughout the trouble, I have never known one to refuse or to object to going into any situation, despite there being destruction all around them.
There have been achievements in cardiac surgery. The number of cardiac units at the Royal Victoria hospital has increased from three to five. Belfast and, I think, Glasgow

have the highest incidence of coronary-artery disease in the world. I do not have the figures to hand, but I know that they are very high.
I accept that improvements have been made in Belfast, which serves the whole of the north of Ireland, yet patients are still being transferred to London and elsewhere for cardiac surgery. More people in their late twenties and thirties are suffering from ischaemic heart disease. They are mostly in social class groups 4 and 5—unemployed people, who cannot afford to look after their health by eating nutritional food. I pay tribute to the health promotion unit of the Eastern health and social services board, which has done a good job in trying to convey that message to people.
I should like to give an outstanding example of the deficiency of hospital trusts. The Royal group of hospitals was the first such group to have trust status in Northern Ireland. That caused great celebration among those who had sought it. Despite the objections of Belfast city council, trade unions, medical and nursing staff and local people, the group gained trust status. Once that had happened, I said that they should accept it.
Within months of the trust being set up, the Eastern health board offered Royal Victoria hospital a contract for 3,000 general surgical and ear nose and throat operations, which was less than it had had in the previous year. If that contract had gone through, it would have been the beginning of the end of the Royal Victoria as a general hospital. It would have continued as a regional hospital.
How was that contract stopped? It was done by a massive campaign in which, thankfully, Catholic nationalists from the Falls road and Unionists and Protestants from the Shankhill road came together to join trade unions in opposing the contract. An Adjournment debate was held on the matter. We spoke to the Secretary of State about it. The result was that Lord Arran, the former health spokesman, would not allow the contract to proceed.
That happened only a short while ago. The next proposal is for the Royal group of hospitals trust to merge with the City hospital, which was made a trust. Where will it all end? The Eastern health board, which offered the contract in the first place, did not even keep to the criteria that were laid down by the management executive of the Department of Health and Social Security in Northern Ireland. I read the criteria carefully, and I assure hon. Members that the contract did not keep to them. If I had more than 10 minutes, I would go into that matter.
Obstetric services are being closed. Lagan Valley, Mater, and Down hospitals are under threat. We are told that, for a service to be viable, 2,000 deliveries are needed. At the same time, a maternity committee has been set up to consider midwifery-led and GP-led childbirth, which I support. How can a committee consider such a proposal when a major maternity hospital is being closed and three others are under threat? It does not make sense.
Fundholding seems to work on Humberside, but I do not see it working in Belfast. It is early days, however, and there are few fundholders at present. I understand that if a fundholder can save money and use it to care for patients, his allocation for the following year is reduced.
Musgrave Park hospital is the main orthopaedic centre for Northern Ireland. It is a fantastic hospital. If any hon. Members need a new hip, I recommend that hospital, which will measure them up as if they were being fitted with a suit. Threats hang over that hospital as well.
Belvoir Park hospital, the main unit for oncology and cancer services, is also under threat. It is located in beautiful green territory and the proposal is to move services to one of the main Belfast hospitals, which would be a disaster. Orthopaedic waiting lists are massive. People on the cardiac waiting list die as they wait for surgery.
There are no problems with acute services and admissions, but people who may have cancer have to wait for proper investigations to be conducted. If the cancer is at an advanced stage, they may be treated too late.
The idea of community care and of elderly and handicapped people being kept in the community, which all hon. Members would support, is not new. Assessment of such people is important. Everybody wants to keep their grandmother or friend with a failing mind in the community for as long as possible, but somewhere along the line, if it is unavoidable, those elderly people have to go into an institution. Elderly people's homes are being closed, so something is wrong with social policy.
The issue of accountability appears in Labour's motion. Where is the accountability? I have not heard Conservative Members talking about accountability. They do not accept that the health service has any faults, yet there is no accountability.
Legislation on child care in Northern Ireland, where it is a major problem, has to be considered.
The Huston report, which deals with Northern Ireland, will come out either tonight or tomorrow morning. It investigated major cases of sexual abuse in Belfast. It contains 52 recommendations and is about the breakdown of information between statutory and voluntary bodies and it should be sent to every hon. Member.

Mr. Sebastian Coe: My immediate remarks are directed at the hon. Member for Belfast, West (Dr. Hendron). I do not wish to question his knowledge of community care in that area, but Tory Members have not been crowing. Nor do we wear rose-tinted spectacles. We are rightly proud of the changes in health care in this country recently. That must be set alongside the system that was changed.
It must be remembered that, for every pound that was designated for patient care before the reforms, significantly more was being spent on a system that was simply waiting for reform to happen. Money was spent on funding a creaking management structure which was allowing it to happen. By most assessments, the organisation lacked sense, magnitude and direction. That was rationale enough for our recent reforms. The concern of Tory Members for a considered evolution to an institution that has at its core a focus for the needs of patients and its users is laudable and undiminished.
There was no overt conspiracy in the past to subvert the national health service from considerations of good management, effective resource allocation and monitoring. It did not happen because no culture or environment expected it, or even demanded it. It was a culture where costs were never properly assessed, altered demographics were not taken into consideration and advances in technology were discounted. Such advances have provided a raft of new techniques and disciplines which were the stuff of fertile imaginations and daydreams only a few

years ago. Of course, they are now the everyday reality for many people, freeing them from pain and discomfort, and badly curtailed life styles.
One of the inevitable results is that people live longer. The Secretary of State was right to point out that, in living longer, people may also need more expensive and technical treatment. All of that adds up to the overall resource implications and cost of patient care which should lie at the heart of this debate. It goes without saying—and here lies some criticism—that those who conceived the idea of a national health service did not anticipate the rapidly rising costs with which it was presented almost from the word go.
Confronting the issue of resources and their effective allocation is one that Opposition parties have simply failed to confront in any systematic way—certainly, so far in this debate. But that is hardly surprising. To imply that the path to salvation lies only in a greater level of funding is certainly not surprising. But to pass off that rhetoric as a coherent strategy—even if they believe it—poses the greatest threat to the national health service and patient care in this country.
Equal in that danger is the elevation of the national health service to the point at which it remains untouched by the realities of greater demand and the ever-increasing public expectation of improved conditions, care and service. It sets deliberately false trails. It is misleading and makes no serious contribution whatever to the debate about how the national health service should be judged.
There can be only two indices of assessment. Efficiency and effectiveness can be measured only by the quality and quantity of patient care that it delivers. On both counts, the reforms have produced quantitative improvement. My hon. Friend the Member for Harlow (Mr. Hayes) was right to mention that, and I am not ashamed to repeat it. More patients are being treated than ever before. The length of time that patients wait for treatment has fallen sharply.
There have been increases in spending each and every year. The proportion of our national income which is devoted to the national health service will rise this year to an estimated 6 per cent—1·5 percentage points higher than when the Government came to power. Those realities are neither the politics nor the statistics of neglect. To suggest otherwise is disingenuous. In fact, it is downright dishonest.
The national health service is the largest employer in Europe. One could be forgiven for thinking that for some, that is the only indicator which will be considered. The proper use of the public purse, the efficient use of scarce resources and the better care of patients are not a happy accident. This is not the managerial version of "It'll be all right on the night". It comes about by one thing, and one thing alone—good, effective and sensitive management, and committed medical professionals.
To push through operational changes without necessary management changes would be ridiculous. That is why, since the mid-1980s, the Government have progressively—strengthened national health service management. The populist view that an under-managed service and weak management—and worse, under-valued management—are compatible with the pursuit of an ever-improved service is a dangerous myth.
It is interesting that most debates in the House dealing with the provision of public services are spiced with spurious Opposition claims of rock-bottom staff morale, whether they be teachers, local authority workers or the police. Yet I have heard only the most demotivating


barrage of abuse about dedicated professionals. I am sure that Unison was listening with great interest to the support from its comrades in arms and the comments about many of its members. Does the morale of management not count when it comes to fraternal concern? Apparently not.
Managing the new NHS cannot be done on the cheap. It certainly will not be done by abusing managers and staff. Of course, we must be alert to the need at all times to keep management cost effective and streamlined, and keep waste to a minimum. It was right that my hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale) put this into perspective. General and senior managers in the national health service still account for little over 2 per cent. of the NHS work force and about 3 per cent. of the annual wage bill. I should, add that, in any management model, those are not unacceptable statistics. Administrative and clerical staff, many of whom directly support nurses and doctors, account for 11 per cent. of the wage bill. The overwhelming draw on the budget remains those staff who provide care to patients directly; they account for some 65 per cent. of the wage bill.
The reforms of the late 1980s paved the way for the recent changes in management structure which were aimed at reducing bureaucracy, minimising administrative costs and aligning the structure of the NHS more closely with the purpose of the reforms. The merger of district health authorities with family health service authorities will simplify and clarify managerial roles and responsibilities. Regional health authorities were part of that outdated culture. Their abolition was rightly welcomed by health professionals across the board. The streamlining of NHS management executive supports those changes taking place lower down the management dynamic.
Taken as a group of measures, there is much to be welcomed in the Government's plans. As with previous reforms, their success will depend on the careful monitoring and constant control of management costs—both set against explicit targets. But we must never forget that these controls should not become so restrictive that they prevent managers from carrying out their duties effectively. The national health service must be run by managers on the ground with doctors and nurses contributing to the decision-making process in the wards and in surgery. The most fundamental aim must be to improve health care.
The majority of people who use the national health service are satisfied users. Poll after poll has identifield that. People are not scared of the changes. Improved management touches large parts of their lives, whether in the public sector or in the private sector. They are right to demand it—they want to embrace it.

Mr. Jim Dowd: Earlier, a Tory Member put up what is a fairly usual smokescreen for the Tories by saying that they have a right to claim that all the parties in the House can take credit for the national health service. It is certainly true that all the parties would like to take credit for the NHS. However, the Tories have the greatest difficultly because, of course, about 40 years ago they voted against the establishment of the national health service. That has proved a great difficulty for them ever since. It is the one issue which cuts most directly against

the free-booting rhetoric of the market that is so beloved by the simple-minded ideologues who seem to have taken the Conservative party hostage for the moment.
They have the greatest difficulty with the NHS—it is the rock upon which they founder—because the NHS accords with the highest ideals and the fundamental needs of the British people. The Government's approach to the NHS must be set against that. The NHS will not stand the full frontal assault which they have exhorted in other areas, so their approach needs to be far more subtle.
The motion tonight relates to waste and bureaucracy in the NHS. I want to go back over a few Tory reforms, not just the most recent reforms but those which immediately preceded them. Every Conservative Government have seen it as their role to reconcile their initial, fundamental and innate hostility to the principles of the NHS with the fact that they have to run it.
In 1974, for example, there was a reorganisation under Sir Keith Joseph, as he then was, which established the area health authorities. I was appointed to the area health authority, then called Lambeth, Lewisham and Southwark, that was formed as a result of the reorganisation in 1974. In 1984, we had the district health authorities. I went on to serve on Lewisham and North Southwark district health authority, which principally embraced Guy's hospital, Lewisham and a few others.
There was then the cash crisis of the winter of 1987–88, when the previous Prime Minister was forced on one of the few occasions during her premiership to back down in the face of public pressure. Rather paralleling her similar experience in 1981 with the miners, she did not take the matter lying down and set in train a series of events which was designed to reorganise the NHS and, more particularly, to wreak her revenge upon it. The consequence of that came to fruition in 1990, when we got the regime under which the NHS currently operates, with the emergence of self-governing trusts.
What are those trusts? They are collections of self-appointed individuals, who asked nobody whether they wanted them to take over the health service. They have consulted no one who would be a beneficiary of those services. They just selected themselves and decided that they would provide the health services in an area because they knew best. We have particular experience of that in Lewisham and North Southwark, because we had the flagship trust of Guy's and Lewisham launched upon us.
Those of us at the Lewisham end of that were particularly concerned. We were told that Lewisham hospital, as a relatively insignificant district general hospital in the shadow of a major international institution like Guy's, had no conceivable future away from Guy 's hospital. We were told that there was an umbilical and incontrovertible link between Lewisham and Guy's. To coin a phrase, what was needed to improve the health services in our part of south-east London was an ever-growing union.
Then came the Tomlinson report. More than anything, that report was a substitute for the fact that there is no single regional health authority in London. Many of the problems in London's health services will not be solved until such a time as there is a region-wide London health authority. The other reason for the emergence of Tomlinson was the immense distortion which the internal market was creating, not just across the country, but in London in particular.
The Tomlinson report has brought in its train serious threats to some of the finest centres of medical excellence in the world. People from overseas look aghast that we should even be considering closing centres like Bart's or University College hospital or Guy's or St. Thomas's. They think that we must be several light years out of our skulls, or at least that the Government are.
What else were we told by Tomlinson? We were told that the link between Guy's and Lewisham was now no longer necessary, because Guy's would be linked with St. Thomas's. We were assured by the self-same people who, a couple of years ago, told us that Lewisham had no future other than being linked with Guy's that Lewisham could stand happily on its own and would, in fact, benefit from being a separate trust. I can only suggest that there were either lies three years ago or there are lies now, because both cannot be true.
More embarrassing for those who are currently running the trusts is that the same people were telling us that those two conflicting stories were both true. So now we have a trust in Lewisham and a separate trust at Guy's and St. Thomas's. What Tomlinson came up with for Guy's and St. Thomas's was a merger on a single site. Anybody with any intelligence could see what that means. Either Guy's or St. Thomas's will close, and either over the river or further down at London bridge there will be a single sign saying "Guy's and St. Thomas's hospital". The entire nation is to be asked to believe that that is the continuation of Guy's and St. Thomas's, but it is a mask for closure.
The health authority has been through a metamorphosis. While the trusts were being set up, there was an imbalance—particularly as the flagship was moored so close by. Incidentally, it is now obvious that the flagship trust was sailing under a flag of convenience, which was that of expediency. The authority had to look at another way of matching the producer-provider split. That idea has not just dropped from the heavens. It is not a revolutionary idea—the producer-provider split in the public services is as old as public service itself.
We are arguing about the way in which it operates and the system under which it operates. The district health authority at Lewisham and North Southwark got together with what was then the authority for Camberwell and West Lambeth and created what was informally known as the south-east London commissioning authority. After due consultation, they decided to formalise a split with the commissioning authority, and we had something called the South East London health authority. That was formed, amazingly, out of the London boroughs of Lambeth, Lewisham and Southwark. Those hon. Members who are still awake will recall that I mentioned the area health authority which was formed in 1978 out of Lambeth, Lewisham and Southwark.
I was just getting used to the South East London health authority, when I got a letter at the end of 1993 from an organisation called the Lambeth, Southwark and Lewisham health commission. This has all happened within a space of a few months. The only people who have benefited from the upheaval in south-east London are public relations consultants who have designed logos and printers who have designed letter headings.
The Lewisham trust, meanwhile, has announced for the fifth time to my certain knowledge phase 2 of the

development of Lewisham general hospital. This is the fifth time since 1984 that that major step forward has been announced. On the other four occasions, it came to nothing. Let us hope that it is more successful on this occasion.
The chairman of the Lewisham trust resigned after I placed questions on the Order Paper asking what the hell he was doing launching a £100 million carpet company at the same time as he was supposed to be running a hospital. I accept immediately that carpets are important in hospitals, but I would much rather have somebody in charge who knows about health rather than about carpets. I asked questions about what he was doing and he resigned a few months later, I am pleased to say. However, we are left with his legacy.
It is clear that the NHS is not safe in the hands of the Government, and not safe in the hands of the Conservative party. The British people know to their cost that it is not the protection of the Tories that the NHS needs, but protection from them.

Mr. Nicholas Winterton: I congratulate the hon. Member for Belfast, West (Dr. Hendron) on his rational speech. He showed that he has a refreshing knowledge of the health service in Northern Ireland. The hon. Gentleman is now accompanied by the hon. Member for Belfast, South (Rev. Martin Smyth), whom I know well. He has served on the Health Committee and its predecessor Committee for many years, and there is no doubt that Northern Ireland is well represented in the debate.
I also congratulate the hon. Member for Belfast, West on what I consider to be a sensible remark. He said that the Government have done a lot of good for the health service and indeed they have. Some of the reforms have been beneficial and should be carried forward. The hon. Gentleman added that the Government are not prepared to listen to criticism. They are not prepared to listen to people who have a point to make. He said that the Government appear to think that any criticism comes from people who do not want to know anything about the reforms that the Government have introduced. He believes that the Government consider that those people are foolish, that they believe in a different philosophy and that therefore they need not be listened to. I think that people should be listened to.
Although I warmly welcome a number of the reforms that the Government have introduced, certain problems have arisen. Unlike the Opposition, I would not abolish fundholding practices, but I would ensure that every practice was a fundholder. That would put all practices on the same footing.
The hon. Member for Bristol, South (Ms Primarolo) will respond for the Opposition and I say to her, as a Conservative and a member of the Government, that I accept that there is a two-tier system. I have had many instances in my own constituency of such a system operating. Patients in a fundholding practice are offered immediate treatment, whereas those in a non-fundholding one are made to wait because the district health authority or the regional health authority has run out of money. The hon. Lady and every other hon. Member could cite similar examples. It is interesting that fundholding practices do not


appear to run out of money, just district health authorities. I do not have time, unfortunately, to talk about the allocation of resources.
I respect my right hon. Friend the Minister immensely, despite our many differences since his appointment to the Department of Health. Many of the Government reforms are good and should be supported, but my right hon. Friend and his ministerial colleagues, particularly the Secretary of State, should listen to constructive criticism, because everything in the health service is not rosy.
I accept that there is a lack of morale and a sense of uncertainty within the NHS. I say that as a Conservative, so my comments will not be welcome, bearing in mind the theatrical performance from my hon. Friend the Member for Harlow (Mr. Hayes). People wonder whether the Government are committed to the health service, as we know it and as I believe it should be. People are concerned about whether functions are being gradually weaned away to the private, independent sector or charitable sector of the hospital service.
That process has already affected community care and the care of the mentally ill, the mentally handicapped and those who are suffering from aging illnesses. They are no longer looked after in the NHS, but in private nursing homes, private residential homes or charitable, non-profit-making institutions. That is dangerous, because the health service is now dominated by its concern for treatment. It is gradually squeezing out care, but to my mind the provision of such care is a vital part of our NHS. People who work within the service, especially nurses, express that concern to me over and over again.
Macclesfield has a superb district general hospital. I congratulate the regional health authority chairman, Sir Donald Wilson, on the resources that he has allocated to that hospital and the extensions that have been made to it. I also congratulate him on the additional facilities that we have bought, because, I am glad to say, a private hospital went into liquidation. It had been built on health authority property next to the district general hospital and, as a result of its failure, we now have a superb orthopaedic department, at a third of the cost of providing one from scratch.
Nurses are overworked and are under immense pressure. They tell me that they were taught to care, but that they do not have time to care, even for people who are dying. My right hon. Friend has an immense experience of the medical profession and surely he would agree that a person should die with dignity and be offered care, compassion and love. The people who can give them that do not have the time to do so.
The debate is about bureaucracy and administration. Whatever my hon. Friends may say, there is no doubt that the system has created a huge bureaucracy and a huge additional administration. Senior management have increased from 1,000 to 10,000. It is not as though those people are still paid between £35,000 and £40,000 per annum. They now earn between £80,000 and £100,000 and receive big bonuses, cars, perks and various other benefits. They are extremely costly to the health service. Administrative and management personnel have increased from 10,000 to 35,000. My right hon. Friend may justify expenditure on those functions and claim that it is worth while, but a lot of that money should be going to patient care.
It is difficult to cost care. It is quite easy to cost treatment, but my right hon. Friend does not know how

much care a particular patient will need. If commercialisation is to dominate our hospital service, one of the most valuable assets of our service, the care that is offered to sick people will disappear. That would be extremely sad.
I recently wrote to Sir Donald Wilson, because, although I pay tribute to him for reducing waiting lists and, perhaps, for running the most efficient region in the country—as he, or should I say his public relations department, is wont to say—I can only say that Macclesfield looks rather like a war memorial. Although I have a first-class trust chairman in Mr. Peter Hayes, a first-class board, both non-executive and executive, and first-class staff at the district hospital, what has happened to health facilities in Macclesfield?
The Mary Dendy hospital and the Alderley Edge community cottage hospital have been closed. The Soss Moss hospital is to close. Parkside hospital, one of the finest mental health hospitals in the country, is to close, despite my opposition, which I have voiced throughout the time, nearly 23 years, in which I have represented Macclesfield.
The young persons unit, which treats young people with behavioural problems, has the most outstanding reputation of any such unit. It, too, will be closed because it has a low profile in terms of the service that it provides and therefore it is a low priority on any purchaser's list. At the same time, the district hospital will provide an after-school sex clinic. The authority has got its priorities slightly wrong, because to abolish a unit that is a success story and to duplicate existing facilities in my community is a mistake.
The health authority has also decided to close the Priory unit, which treats those who suffer from alcohol dependence. The carers, the staff and those who use that unit want it to survive, but, oh no, the health authority wants it to close. The authority has informed my trust that it will not purchase any places at the unit and that its patients should be treated in the community.
I have received pleading letters from my constituents whose lives have been saved by the unit, but where is the consultation about which we hear so much? My hon. Friend the Member for Broxbourne (Mrs. Roe), who now chairs the Select Committee on Health, talked about accountability, but where is it? There may be accountability to Ministers and Sir Duncan Nichol, but there is none to the local community which is served by the health service.
The decisions in my area are not even made by the chairman of the district health authority, County Councillor Simon Cussons, but by Sir Donald Wilson, and I give him full credit for his experience. That health authority was merged against the wishes of my local authority, my wishes and those of the community health council. Now, it is not even located in the area that it serves, so how can it offer an acceptable level of accountability?
I urge my right hon. Friend to use the good reforms that we have introduced, but we should implement them in a way that is acceptable to the people of this country, the people who serve in the NHS, and particularly the patient.

Rev. Martin Smyth: I am glad to follow my parliamentary friend and erstwhile colleague on the Select Committee, the hon. Member for Macclesfield (Mr. Winterton), because of his concern in health.
The hon. Member for Falmouth and Camborne (Mr. Coe) gently chided the hon. Member for Belfast, West (Dr. Hendron) for overdrawing the picture. Unless my knowledge of quotations is completely wrong, he was quoting the director of Booz Allen and Hamilton, speaking in December, when he compared spending £1 directly on patient care and £4 on aspects of indirect care. I had the impression that that had been changing as a result of the Government's reforms, whereas the director was implying that that was still going on. He said:
For every pound spent directly on caring for the patient, £3-£4 is spent on writing things down, scheduling work, and waiting for work to be required.
We must face some of the issues that remain with us. I pay tribute without reserve to the work that has been done over the years through the national health service. I have campaigned for it, but I do not believe that it has been perfect. Indeed, I do not believe that anything that a human puts his hand to is necessarily perfect. We should therefore always strive to improve.
In that context, I pay tribute to the recent honour that the Minister for Health has received. When I raised a question during the paediatric statement, he missed the point that I was making and said that he would refer the matter to the Earl of Arran. I received an acknowledgement that he had done so and, amazingly, I am still waiting for a definitive reply.
Paediatric orthopaedics is an example of the weakness in the national health service. It has a tremendous need to deal with youngsters, and one of the finest provisions in the United Kingdom is provided by Musgrave Park hospital. I knew that the Minister had personal experience of it. I acknowledge that the North British Tours organisation has given another generous donation from private enterprise to fund the work carried out at the hospital's Gait unit. I was amused to receive an oblique reply referring to the orthopaedic surgeon handling the work at the children's hospital.
I cannot understand why the Department continues to write to Members who raise issues detailing facts that the Members already know rather than dealing with the problems that they raise. He told me that Kerr Graham was the surgeon, but he had already written to me to thank me for the interest that I had shown.
I am not knocking at the health service but pleading for continued improvement in it. I understand the views of the hon. Member for Falmouth and Camborne on care because, on Tuesday this week, I was travelling from Belfast with one of Northern Ireland's finest comedians, Frank Carson, who paid tribute to the hon. Gentleman's concern for social care.
The earlier part of this debate seemed, with sound and fury, to signify nothing. We must get beyond a partisan approach so that we can come together to help and improve. Some people constantly seek to defend their own patch. It is interesting to discover that the pharmaceutical industry is adamant that we should not curb drug production because only 10 per cent. of the national health budget is spent on drugs. Yet there is 10 per cent. wastage in the health service, so why take it out on drug manufacturers when what they supply equals the waste? Nobody will suggest that the waste occurs only in the drugs budget.
Hon. Members complain that we knock the managers. As I said in Committee earlier today, I put on a blue suit because I was not knocking the men in grey suits. None the less, we need to examine the growth of the managerial approach. Figures that were given to another hon. Member suggest that 36,000 more managers and 27,000 fewer nurses are employed than before the reforms. I appreciate that statistics can be confusing, because those figures refer to the whole United Kingdom from 1989–90 onwards and include nursing auxiliaries and pre-Project 2300 nursing students, whereas the Department of Health figures in the statistical bulletin exclude Northern Ireland and apply only to qualified nurses.
It is, therefore, difficult for hon. Members asking questions in this place if they do not get clear answers. Perhaps some of us are still living in our school days, when we gave a vague answer to try to gain something from the examiner because we did not have the full answer. I suspect that there are still more nurses in patient care, because one must add to the number of nurses involved in the health service those now involved in private residential and nursing home provision.
The fashion of provision on acute sites is one of the issues raised in the London review. It is argued that we should not have specialised, free-standing units, but that they should be on acute hospital sites. I share the concern of the hon. Member for Belfast, West about the suggestion that one of the finest cancer units in the United Kingdom, at Belvoir park on the outskirts of Belfast, serving the whole region, should be on an acute site, whether the City or Royal site. The Minister will agree that the City or Royal sites could not even cope with the parking facilities now available at Belvoir Park. To destroy that wonderful provision because a fad in medicine says that it must be on an acute site would be lunacy.
We must challenge some of the thinking in the medical profession for which politicians get the blame when, in fact, the changes have been driven on by advances in medical care and technology. The poor politician must then provide the money and carry the can for those decisions. The public must realise that medical folk have their own agenda.
The hon. Member for Macclesfield referred to community care and the move to private provision. The tragedy is that now, with the new programme—in time, the Government want to try to extend community trusts to the rest of Britain—we are discovering that private residential facilities in Northern Ireland are closing. People are afraid that there will be no provision for the elderly, the mentally infirm and others. We are decanting them and relying on their families, without proper respite provision or back-up in community care.
We must constantly keep alert to those issues, so that we maintain the best health service that the world knows.

Mr. Stephen Day: First, I declare an interest. I am the parliamentary consultant to the National and Local Government Officers' Association section of Unison, and I am proud so to be. Some of the comments in the debate may be construed by members of that union to be an attack on them. That is unfortunate, because many members of Unison work in the NHS and many members of NALGO work in the administration of that great service.
It has been said today that, as a Government and as a party, the Conservatives should listen to criticism about the present workings of the national health service. That is right, and that is what the Government do. Only recently, the Secretary of State responded by announcing an initiative issuing new NHS codes for accountability, probity and financial control, for which I applaud her.
The NHS is a vast service, which employs many people, and it would be surprising if there were no instances of genuine distress involving individual patients at specific hospitals. When such stories are related by Opposition Members, they are valid and particularly pertinent to the patients who suffer. But such tales do not tell the other side of the story—the vast number of patients who are treated by the NHS and are well satisfied. I am constantly amazed by the number of people who come to me, either in my surgeries or as I am wandering around the constituency, and say that they have received wonderful service from the NHS. They are often elderly people.
Opposition Members often cite examples of patients who have been kept waiting for what everyone agrees are unacceptably long periods. It is fine if Opposition Members do so to try to improve the service, but they do not. They do so in an attempt to attack the integrity of the Government and the NHS by continually alleging that that is the true picture.
That is why I had some sympathy with the hon. Member for Belfast, South (Rev. Martin Smyth) when he said that in order to deal with the problems we need a consensus. That is necessary if we are genuinely interested in saving the NHS for the future—the task before us. All hon. Members know the pressures on the service. They are shown not just by the individual difficult circumstances already mentioned, but by the massive number of patients successfully treated by the NHS. Success identifies the problems faced by the service, but that aspect has hardly been mentioned in today's debate.
The idea that a service designed to meet the needs of the 1950s could be retained in a fossilised form without change is bizarre. The NHS could not possibly have met the needs of the 1990s in its original form. Even now, the NHS is not perfect. Given the pressures that it is under, I suspect that it never will be. Nobody in the House can deny that the NHS has never been perfect. The problem of patients having to wait too long did not suddenly occur when the reforms were introduced. Indeed, the reforms were an attempt to deal with that problem.
Nobody can promise to eliminate that difficulty, but it does not serve the interests of the House or the subject when hon. Members constantly and only relate the downside of the equation. Even with the shortest of waiting lists, someone will always have to be last on the list. Hon. Members who are constantly on the attack by reminding us of the person who comes last are not helpful. According to them, the NHS cannot win, but it is not good enough merely to say that.
The NHS is a great institution. I am proud to say that I rely totally on the NHS for my health provision. I thank God that I have been lucky enough not to have use the services of the NHS except for specific injuries. The NHS has been successful, and more people are living to a greater age. We all welcome that and hope to be part of the problem. In the light of the temperature in here sometimes, I am not sure whether it is the best place to be to become part of that problem for the NHS, but I shall try.
Parliament and politicians must recognise that to provide for people in old age requires changes. We must constantly fine-tune the system and the changes. If the Opposition criticisms are designed to help that fine tuning, they are valid, but I do not recognise such criticisms in what they have to say.
I cannot remember who it was but, during the debate, an hon. Member related the problems that one of his constituents faced waiting for a cataract operation, and his story proves my point. The number of people waiting for cataract operations originally began to grow—despite the Government's partial success in that sphere—because the NHS was so successful that more people began to live to an age when they suffered cataracts. We must recognise that problem if we want to save the NHS. As someone who uses the NHS, I have faith that the reforms are not a threat to the principles of the NHS, but its salvation.

Mr. Alan Milburn: I pay tribute to the brave and forthright speech of the hon. Member for Macclesfield (Mr. Winterton). He highlighted what happens when a Government become so obsessed with ideological ends that they put their obsession ahead of a commitment to the most popular of all public services in this country, the national health service. The Government have taken no account of the costs of their policies.
We have heard today that the NHS is in a state of perpetual crisis in all parts of this country. I do not need to repeat the litany of problems already mentioned by my hon. Friends—suffice it to say that the NHS cannot cope with demand because it is so short of supplies. I should have thought that a Government so committed to the ethics of the marketplace would have understood that—the first principles of economics. For any enterprise to succeed, it must be able to meet demand with adequate supply. If one closes one fifth of one's capital assets—hospitals and acute wards—and fails to protect investment—the NHS budget—from the ravages of inflationary costs, one's enterprise will inevitably fail to keep pace with demand. Is that not the homily that we have heard from successive Chancellors of the Exchequer, Prime Ministers and Health Ministers?
Such a scenario is bad enough when it afflicts an individual firm, but when it comes to pass in an institution' as vital to the health of our nation as the NHS, the country's alarm bells should start to ring. What is at stake is the health and future of our nation. The NHS is in danger of imploding as a consequence of the combination of underfunding, rock-bottom staff morale, public disquiet and the Conservatives' market changes. The straw that: may finally break the camel's back is the boom in bureaucracy of recent years.
We all know that times are hard, that precious resources have to be husbanded and that we cannot do everything that we would wish to do immediately. If we ask members of the public where they want their hard-earned tax revenues to be spent in the NHS, they say that they want more doctors, nurses and midwives and more expenditure on medical equipment. I bet that no one would say that they want more bureaucrats or managers, but that is precisely what we have. In the midst of famine, there is a feast of bureaucracy.
There is the starkest contrast between the problems that my constituents face as health care providers and people requiring health care and the boom in bureaucracy over recent years.
The NHS is becoming more secretive, centralised and top heavy. It is in danger of becoming a service where the daily growth in the number of chiefs is matched only by a fall in the number of indians.
The position is now sufficiently clear. The Department of Health's own figures paint the starkest picture. There were 14,000 more managers, 22,000 more administrators and 27,000 fewer nurses in the United Kingdom's national health service between 1989 and 1992. The introduction of the Conservatives' market changes saw a 236 per cent. increase in managers and a 5 per cent reduction in nurses.
Ministers have formed an army of bureaucrats which is strangling the NHS with more and more red tape. The internal market is sapping the health of the nation with a booming bureaucratic burden in contrast to Ministers' promises. We were promised a leaner and a fitter national health service where resources would be freed for better patient care. It is not leaner or fitter; it is fatter with bureaucracy.
Ministers say they are determined to hold down administrative costs. The Secretary of State claimed in her statement to the House last October that the abolition of the regional health authorities
will slim down NHS management".—[Official Report,
21 October 1993; Vol. 230, c. 400.]
She repeated that claim earlier today, but, as the right hon. Lady must know, axing the regional health authorities will do no such thing. They have been sacrificed, not in an effort to cut down bureaucracy, but to stamp out the last vestiges of proper planning in the NHS.
If the proposals go ahead, the distinctive health needs of my region, the north, will be swamped in a larger, less accountable organisation run from the centre by the hand-picked appointees of the Secretary of State for Health.
As for the claim that it will mean fewer managers, who on earth do Ministers think they are kidding? In 1992, out of a total of 710 managerial staff in the national health service of the north, just 88 were directly employed by the regional health authority. The Secretary of State quite simply has the wrong target in her sights if she is serious about reducing NHS bureaucracy. Its growth owes nothing to the planning work of regional health authorities and even less to the redesignation of nurses as managers; it owes everything to the introduction of a new contract culture at hospital level.
That culture has brought with it the paraphernalia and institutional bureaucracy of the marketplace. We have more financial directors, more pieces of paper, more trading in health care, and more PR specialists and management consultants, and they are all looking to make a killing in the new environment. If the Government really want to cut down on bureaucracy, stamp out waste and end the growth in grey suits, they have to end the market experiment in the national health service.
The responsibility for waste and unnecessary red tape lies with Ministers. They have abused public spending. The annual pay bill for managerial staff in the United Kingdom has trebled—an increase of more than £350

million. In the past year in England alone it has risen by £110 million—an increase of 29 per cent.—while the overall nurses' salary bill has increased by just 5 per cent.
Ministers say that it takes a special person to be a hospital manager and that therefore hospital managers deserve a special reward, but it also takes a special person to be a nurse, a doctor, a porter or somebody working in NHS labs saving lives in our hospitals and communities every day. But what is their reward? A pay squeeze, which damages morale further. It is an insult to NHS staff at the sharp end of health care and it is precisely the double standards we have come to expect from the Government.
That is just the beginning of the story. My hon. Friends have alluded to the growth in corruption within the national health service. I never thought that we would see the day when corruption would become synonymous with the NHS.
In my region we have the Northumbria ambulance service, the jewel in the crown of the NHS trust success story run by a man who happens to be the president of the Tynemouth Conservative association and, I understand, of the Tynemouth boy scouts as well. Mr. Stewart and his friend Mr. Caple have very good track records. There are personalised number plates for NHS ambulances. They pop over to America and buy a new fleet of ambulances—

Madam Deputy Speaker (Dame Janet Porter): Order.

Mr. Roger Sims: The motion alleges lack of accountability within the health service, and I would dispute that. Health authorities and trusts are answerable to local people, including local Members of Parliament. They are answerable to the NHS executive and to Ministers who, in turn, are answerable to us in the House by way of letters, parliamentary questions and debates such as we are having today.
I do not consider the first leg of the motion to be particularly strong. When Opposition Members talk about accountability, what they mean is that they would like to see health authorities elected and turned into party political bodies, to which my response is, God forbid.
The second leg of the motion alleges a growth in bureaucracy. In the sense that there are now people with management responsibilities that did not exist before, that is correct. It is exactly what was needed in the health service—a clear line in management responsibility.
The third leg alleges waste of resources. That is certainly true. There is some waste of resources, but, thanks to the reforms in the health service, we can now identify and deal with them. At least there is now a mechanism in place whereby they can be handled, which was not the case in the past.
I am not going to quote an over-quoted slogan, so I think that we should go back to why and how the structure of the NHS was changed. The House will recall that, in the early 1980s, we were faced with ever-increasing expenditure in the health service without apparent corresponding improvements in the service, and with lengthening waiting lists. As a result, the then prime Minister set up her inquiry and Sir Roy Griffiths was asked to initiate an inquiry into the management of the health service which he concluded was poor.
There was waste then, but it could not be identified, because we did not know how much things cost. In those


days, if one asked at the local hospital or health authority what was the average cost of a gall-bladder operation or a hysterectomy, they literally did not know. How can waste be prevented if one does not know what the costs are? Not were there clear lines of responsibility. Obviously, resources of cash and staff were not being used as effectively as they could have been, but no mechanism existed to identify where the weakness lay. That was why the reforms were introduced.
The front line of the NHS are the doctors and nurses, who heal and care for patients. Every one of us has benefited from the work they do, but they do not work in isolation. It is easy to scoff at managers and administrators, but without them doctors and nurses simply could not do their work. Any successful industrial or commercial organisation depends on the skills, not only of those who fashion the final product, but of those responsible for managing the premises, for the purchase and supply of materials, and for programming the production process to make the maximum use of facilities within the organisation.
I do not suggest that the NHS is either an industrial or commercial concern, but, in staff employed and the money spent, it is big business. It must be sensible to apply business methods to its administration. Behind those front-line doctors and nurses there are now managers responsible for the premises, for record keeping, for ensuring that drugs and equipment are available when needed, and for effecting a match between operating theatre time, bed occupancy, treatments and patients' needs, thus reducing and, I hope, eliminating, waste.
We now have managers at purchaser level in the health authorities who know the cost of treatments and can allocate resources in the best interests of the local population. By contracts, they can get the best value for the funds that they have available, which are always going to be limited, whatever the ultimate figure. The fact is that the system is working. We are getting more and better treatment for the money spent.
In her opening speech, my right hon. Friend the Secretary of State quoted some national figures. They are reflected locally. In my area, in 1992–93, Bromley health authority purchased homeopathic treatment for 232 out-patients, two day cases and nine in-patients, at a cost of £50,000. In 1993–94, it purchased 320 out-patient appointments, nearly 100 more, for £14,400 as against £50,000 the year before, thus releasing more money for other treatments.
There is a new administrative structure, or, as Opposition Members might like to call it, bureaucracy. But it is working. It is having the effect that it was intended to have. That is not to say that there is not scope for further improvement—of course there is.
We look forward to legislation to reduce the number of regional health authorities. It will also enable the merging of health authorities and family health services authorities. That is already happening in Bromley, in all but name, with advantages all round. It means that referral and discharge protocols have been developed to ensure the maximum benefits for patients, and the most effective use of resources. It has enabled the managing of joint budgets to ensure that authorities are able to make the most appropriate and cost-effective arrangements for the treatment of those for whom they are responsible.
Inevitably, there are problems as new systems are implemented. Hospitals may well complete their contracts

before the end of the financial year, but that demonstrates the need for them to pace themselves and/or to consider whether there are ways of attracting new contracts. All the players are learning by experience in negotiating contracts and in assessing extra contractual referrals that are likely to be needed.
Of course mistakes will be and have been made, arid where they are gross—some examples have been quoted today—that may well be due to sheer incompetence, and appropriate action should be taken against managers who are simply not up to the job.
The organisation and administration of the NHS is not perfect, but at least the Government have had the courage to implement revolutionary changes and have not been afraid to make adjustments and improvements where they are needed. All the Opposition seem able to do is to criticise in a manner that cannot help the morale of those who work in the service, whether as nurses or at management level.
It is not as if the Opposition's criticism is constructive, even though members of the Labour party are actively involved in working in the NHS at many levels. We simply do not know what the Opposition's policies are. Are they in favour of trusts? Would they put the clock back? Are they in favour of fundholding GPs? Yes or no?
Today was the opportunity for the Opposition to tell us what Labour party health policy is, especially since they initiated this debate. Once again they have fluffed it. There has been plenty of criticism but nothing constructive. It is just possible that when the hon. Member for Bristol, South (Ms Primarolo) replies to the debate she will tell us what Labour party policy on health is, but I would not put my money on it.
People will make their own judgments on which party believes that the NHS is a subject for party political point scoring but has no new ideas and which party is wholly committed to the NHS and is constantly working to improve it.

Dr. Lynne Jones: Earlier today we heard a great deal about the large quantities of propaganda material being churned out of the Department of Health. My attention was drawn to a press release dated 6 January with the headline:
NHS must learn to listen and respond to local voices says Mawhinney".
About the same date, a letter signed by 124 consultants—yes 124 consultants, more than 60 per cent. of the consultants in the south Birmingham acute unit—wrote a letter to the Secretary of State which was a cry for help. They are the local voices. They referred to the problems that they experience day to day and to what was going on in our health authority in south Birmingham—a series of reorganisations, relocations and administrative schemes that have consumed funds and countless working hours and have led to confusion, demoralisation and reduced efficiency. That is what 124 consultants working in south Birmingham said about what was going on in our health service.
If they are confused, the people are even more confused. The merger of south and central Birmingham health authorities had been forced through with inadequate preparation by the discredited former chair of the regional health authority, Sir James Ackers, who was appointed by the Government. A new accident hospital was originally


planned for Birmingham as part of plans for major capital investment. Sir James Ackers said that Birmingham had been starved of investment and he put forward grandiose plans, most of which local people.did not want because they concentrated everything on the site of one mega-hospital. That plan was to go ahead and lots of money was to be spent, but, all of a sudden, that money dried up and the plan was shelved.
In the confusion, there were plans to close hospitals to try to save money. The accident hospital was relocated to the general hospital. Now, because we need a new hospital the accident hospital has to move out of the general hospital so that the children's hospital can move into the general hospital. The Royal Orthopaedic hospital that was to move to the general hospital will not now do so, and there are plans to move it to Selly Oak hospital. No wonder people are confused. They wonder what on earth is going on when decisions seem to change from day to day and money which at one time was readily available suddenly dries up.
We know what is happening. Because everyone is moving towards the idea of hospital trusts, new trusts can no longer guarantee that they will have contracts: that means that they cannot plan for the future and cannot make long-term capital investment. That is why Birmingham cannot have a new children's hospital and that is why we cannot have a new trauma unit.
The people of Birmingham have little confidence in the present arrangements. First, they were told that the number of beds in the Queen Elizabeth hospital must be doubled; then, only a year ago, the chief executive of the acute unit—who has now resigned—said that there was a greater demand for beds in that hospital and in the Selly Oak hospital. Last October, however, the new purchasing plans were published: they envisaged a loss of 236 beds. Only two months later, the regional health authority's plans appeared, stating that nearly 500 beds must go.
When I queried the discrepancies, the regional health authority told me that there was one year's difference in its figures; a steep decline in numbers was taking place. Now, the people of Birmingham are wondering whether they will have any hospitals left. The Minister talks about listening to local people, but he does not really want to listen to the voices of people in Birmingham, or to the views of those 124 consultants. I note that the Secretary of State did not mention the letter from those consultants when she referred to the various comments that she had received.
In its propaganda newspaper, "Heartbeat", the regional health authority proudly announced last September that beds, wards and even whole hospitals could be closing across the west midlands as patients and general practitioners exercised their new power to withhold custom from unsatisfactory hospitals. Beds, wards and hospitals are closing; but they are not closing because customers do not want to use them. Waiting lists have lengthened, and every week I hear from my constituents about their difficulties in securing the operations they need.
One consultant recently told a patient, "You are No. 144 on my waiting list of 238. Only very urgent cases—patients with cancer—can get treatment." A group of gynaecologists, frustrated by their inability to take patients from GPs unless they were fundholders, wrote a circular letter to all GPs, letting them know what was going on.

Mr. Whitney: The hon. Lady has made frequent mention of the number of consultants who are complaining about the health service. Can she name a year since 1948 in which consultants have not complained about the state of the NHS?

Dr. Jones: Consultants have never spoken out as they are speaking out nowadays. That is my experience in Birmingham: they have never been willing to speak out in that way.
A lady who came to my surgery on Friday had been in daily pain, needing an operation. The consultant said that she could have the operation in January; there is no waiting list. She has been told, however, that because she lives in south Birmingham she cannot have the operation, because there is no money. A patient about to be discharged from a mental hospital in south Birmingham was told that she would be given counselling sessions and would be able to come in once a week for day care. When it was realised that she lived in south Birmingham, however, she was told that she could not receive that service.
Surgeons tell me that elective surgery is virtually being cancelled in Birmingham. Because of the closure of one of our local maternity hospitals, women are being forced to go out of the district, because the remaining maternity hospital cannot cope with the demand. The situation is ridiculous: patients cannot be given the treatment they need, although there are consultants willing to undertake the work.
I heard last week that, in the Birmingham maternity hospital—which has an intensive care unit for babies—demand is so great that nurses are rushed off their feet, because they are admitting more premature babies in need of intensive care than can be dealt with by their facilities. They are packing them in because they want to make a profit. That is a consequence of the market: we are measuring the success of hospital units according to whether they make a profit rather than the quality of service that they provide.
The internal market is not working in south Birmingham. I urge the Minister of State and the Secretary of State to take their own medicine and listen to the people who experience what is happening every day. Will they please accept our invitation to talk to local Members of Parliament, local consultants, local nurses and the local people?
I am confident that, with proper planning to get us over our current problems which are due to inadequate planning in the past and a lack of capital investment, south Birmingham could have good and efficient services on a reasonable budget. At the moment, however, the health authority is being asked to make impossible savings which are decimating patient care in my constituency and in other parts of the South Birmingham health authority area.

Mr. David Congdon: A few moments ago, a Labour Member accused the Conservatives of being obsessed with an ideology for the national health service—wanting to make it a commercial market and eventually privatising it. I utterly reject that charge, but I plead guilty to being obsessed with ensuring that the NHS provides the most efficient and cost-effective patient care possible. I also plead guilty to being obsessed with wanting to root out waste in the NHS. It was


interesting that virtually all Labour Members criticised the NHS for this and that, but they did not offer one constructive proposal to root out waste.
Listening to Labour Members, one would have thought that they had a magic method of improving efficiency in the NHS and that the experiences of other large organisations could be dismissed. Many large public sector organisations have a record of inefficiency. One need only remember the old nationalised industries—thank God there are very few left—or consider many sectors of local government, especially Labour-controlled authorities, to know the meaning of inefficiency. It is difficult for a large organisation which is spending £100 million a day to ensure that it gets the maximum value for each £1 spent and to remember that every £1 spent badly is £1 less for patient care.
The key test is whether we have now organised the national health service in such a way as to provide greater efficiency and improved patient care. It has been announced—rightly so—that the size and scale of the regional health authorities is to be reduced, and that is to be welcomed. The changes have inevitably led to a reduction in the number of staff employed by the district health authorities because many of their functions have been taken over by the trusts. It is true that the DHAs are spending very little in carrying out the purchasing function, but it is a key function.
There is a split between the purchaser and the provider, ensuring that there is an important distinction between those who decide what the health care needs are and those who meet them. That is also leading to improved efficiency. I believe that fundholding GPs are the key to the future. They are able to determine what they wish to buy without an intervening layer of bureaucracy, but we heard little about that from Labour Members. It is also clear that the way in which the purchasing authorities place their contracts is also leading to better value for money.
Perhaps most important of all are the measures that lead to efficiency. I do not have time to list them all, but we know that more patients are being treated than ever before. That cannot be ducked by Opposition Members.
We know that the measures in terms of indices of efficiency are improving in the national health service. There have been productivity gains of about 32 per cent. during approximately the past 10 years. There have been productivity gains of 1·9 per cent. last year and 2 per cent. this year. The NHS is a success story and we are determined to ensure that it continues.
To listen to Opposition Members, one would have thought that there was no need to have managers in the health service who monitor what happens. We know that the performance of individual hospitals varies greatly; length of patient stay varies considerably ; the amount of use of operating theatres varies widely up and down the country. The challenges for the health authorities—it has not changed for many years—is to ensure that the standards of performance of the worst areas come up to the standards of the best, because there are such wide differences. We must aim for that.
The health service in London was also mentioned. Some difficult problems need to be resolved. We know that the number of beds in London needs to be reduced. My plea to Ministers is to control the pace of change in London, because we cannot afford to reduce the number of

beds too quickly. We have to ensure that the number is reduced in line with other changes, especially in primary care, in London.
The motion that we are debating is a sham. The Opposition are not interested in the efficiency of the health service. We have heard little about what they would do to improve it. They wish to have a large, monolithic organisation, with the producer interests put first. We wish to ensure that the interests of the patients are paramount. That is why it is important to continue with the reforms that are leading to improved efficiency and—perhaps more important—improved patient care.

Mrs. Jane Kennedy: Like the hon. Member for Cheadle (Mr. Day), I am associated with Unison as a sponsored Member and I have been a member of the National Union of Public Employees since 1979. I will not accept instruction from the hon. Member for Falmouth and Camborne (Mr. Coe) on how to represent Unison members. I fought the proponents of permanent revolution in my party and I will fight the idea of permanent revolution in the NHS with every breath left in my body.
I wish, however, to give the Minister the opportunity to take action that will halt the waste of £9 million of capital investment and at least £4 million of revenue costs per year—a waste of resources which, I believe, will have a direct and detrimental effect on the care of cancer patients in my constituency and which has not yet happened. There is an opportunity for the Minister to do something specific that will halt waste in the health service.
The Secretary of State said that it was crucial that the management of resources for the NHS should be effective. I agree with her, but a proposal is being considered by the NHS directorate of the Welsh Office to develop a cancer treatment centre at Glan Clwyd hospital in Bodelwyddan, north Wales.
The Welsh Office believes that Wales should be self-sufficient in the provision of services to its people. That has reached the point where services that are provided to Wales from England are to be substituted by provision in the Principality, irrespective of the financial illogicality of it or of the impact on the quality of service that will be offered in return.
The north-west of England and north Wales are well served by the two cancer treatment centres at Christie's in Manchester and Clatterbridge on the Wirral in Merseyside. Christie's, marginally larger than Clatterbridge, draws its patients from east Cheshire, Greater Manchester and Lancashire. Clatterbridge patients come from Merseyside, west Cheshire and north Wales—specifically Gwynecld and Clwyd.
The patients travelling from north Wales for diagnosis and radiotherapy have long distances to travel and usually stay overnight or are admitted as in-patients to Clatterbridge. I can understand how that must add anxiety to an already stressful and worrying time for patients and their families. However, the current proposal from the Welsh Office to develop an independent radiotherapy service at Bodelwyddan does not make financial sense, will not improve the quality of service provided and flies in the face of recent concerns about the non-uniformity of the quality of cancer treatment throughout the United Kingdom as a whole.
According to a Touche Ross report for the Welsh Office, estimates of the capital costs involved vary from £11·7 million to £12·9 million, depending on which site is chosen. Revenue costs would add a further £4 million per annum. The maximum number of patients forecast for the unit is 1,700 per year, and the expected number is 1,400 per year. That could never be enough to allow a centre of excellence to develop, and even those numbers could be achieved only if the health authorities of Gwynedd and Clywd committed the vast majority of their patients to the new centre, which would remove all choice from patients and their GPs.
Furthermore, I understand that Glan Clwyd hospital, the most likely site, has asked that the cancer centre's funding should be ring-fenced and underwritten by the Welsh Office. Otherwise, failure of the proposed unit could wreck the financial viability of the Glan Clwyd trust and damage the services on offer there. Such an open-ended financial commitment to the north Wales centre would inevitably be a drain on funds for the treatment of patients in England, and my constituents in Broadgreen would suffer because of the limitations that would be placed on the development of new treatment at Clatterbridge.
The Clatterbridge centre for oncology cares for about 6,000 patients a year, nearly 900 of whom come from north Wales. Its size has allowed it to develop a unique combination of people and equipment. Its neutron accelerator is used in the treatment of eye tumours, and that requires the support of specialist staff, who produce facial masks to hold the patients still while the treatment takes place. It is inconceivable that such treatment would be available at Bodelwyddan, so some patients would still have to travel to the larger centres of Clatterbridge and Christie' s.
However, if Clatterbridge lost the 900 patients from north Wales, how would its own financial viability be affected? Obviously unit costs would increase. How long would it be before the case was made by the people whom we have come to know as "the purchasers" that we could not afford three cancer treatment centres in such close proximity? As the Welsh Office would be so financially committed to the unit in north Wales, the future of Clatterbridge would inevitably be called into question.
The Clatterbridge centre for oncology has submitted its own proposals to the Welsh Office. I know that the Minister has been involved in that process, and I hope that he will respond at the end of the debate to what I have said.
The Clatterbridge proposals would improve the treatment of patients throughout the region. The centre would like to develop network cancer treatment facilities throughout its present catchment area, including north Wales. That could involve potential for the installation of linear accelerators at Bodelwyddan. Alternatively, it could involve developing facilities at each of the three general hospitals that serve the area. Being part of the Clatterbridge management unit would allow for provision of the high-quality skills and treatment that we need to standardise throughout cancer care.
The capital cost involved would be as little as £2·4 million, depending on which option was adopted. Clatterbridge is developing for all its patients a system of delivering chemotherapy through local clinics, bringing

the treatment to the patients in Southport, St. Helens, Walton and Warrington. North Wales should be allowed to benefit from that system, too.
At a time when the Government's chief medical officer is leading an initiative to improve cancer treatment across Britain through the standardisation of excellence, it seems a great shame that the Welsh Office should be poised to spend millions of pounds on a venture that will not only almost certainly fail to deliver quality in north Wales, but may also wreck the centre of excellence at Clatterbridge. I should be grateful if the Minister could find time to respond to that specific example of bureaucratic nonsense. However, if he cannot manage to do so in the short time that I know he has available, will he respond more fully later?
In the last minute of my speech, I shall deal with some of the nonsense being perpetrated by Conservative Members. When Unison-sponsored Opposition Members speak up and describe the chaos that they see around them in the health service, which has been caused by the introduction of the internal market, Conservative Members say that we are attacking the Unison members working in hospitals throughout the country. But it is nurses who are Unison members who have told me that, in Alder Hey hospital, they can no longer perform the role of key nurse, because they never know from one day to the next which ward they will be working on. They are redirected, as soon as they enter the hospital, to the ward with the fewest staff on duty that day.
Unison members are unable to carry out the professional role that they came into the service to provide. They feel bitter and tell me so. I wonder what they say to Conservative Members. I wonder whether Conservative Members have held surgeries or have opened their mail bags, because after the messages that I have received, not only from those who work in the health service and Unison members, but from members of the public who have written to tell me about operation cancellations, Conservative Members must have been living in a different world.

Ms Dawn Primarolo: Again, the debate on health has been in Opposition time. The Government claim to have had such wonderful sucess in the service, but they reflect and decide not to debate health in their own time.
In the debate, we have considered accountability, efficiency, bureaucracy, waste and the fundamental difficulties with the reforms. The Labour party is trying to make it clear to the Government that a system that is driven by cost, in which everybody knows the price of everything, affects the quality of care. It is true that staff nurses now know the cost of everything, and that perhaps they did not know before. We all know that canisters to warm blood before transfusions cost £60. However, what happens as a result is that they do not use those facilities.
We know that purchasing authorities use different specifications, which means different services are being purchased across the country, with the inevitable consequence of the undermining of the national health service. We know that commercialisation and privatisation mean a defensive, closed, secret system in which trusts, in order to compete, spend more time worrying about their balance sheets and what their neighbours are doing than


about the care of their patients. We know that competition is leading to duplication, where every authority thinks that it should have all the equipment and where planning is diminishing.
Opposition Members have detailed at length the waste, the bureaucracy, the waiting lists, the problems with GP fundholding and the two-tier system, and they have demonstrated how private gain is at public expense.

Mr. Day: Will the hon. Lady give way?

Ms Primarolo: Conservative Members know that I have 15 minutes only. The Secretary of State took 50 minutes. I shall try to make some progress through my speech if Conservative Members will allow and I shall give way if time permits.
My hon. Friend the Member for Don Valley (Mr. Redmond) said that we ought to go "back to basics"—back to the basics of justness and fairness. Conservative Members spent their time saying how wonderful the reforms were everywhere, except in their constituencies, where their hospitals were having problems and they thought that perhaps it was a hiccup in the system. We have heard about bed crises, cheating on figures, and ways in which to squeeze treatment out of the system.
My hon. Friend the Member for Lewisham, West (Mr. Dowd) rightly pointed out that Tories claimed that they supported the NHS, have always supported it and were joint partners with the Labour party. I refer them to the vote in the House of Commons on 30 April 1946, when their Government voted against the creation of the national health service by 359 votes to 142.
As the hon. Member for Macclesfield (Mr. Winterton) pointed out, fundholding means that GPs have independence. That is one of the fundamental difficulties with the system. There is a conflict between the district health authorities and the GP fundholder. GP fundholders are not monitored or directed, do not have to ensure that they are buying the services correctly and are pulling in the opposite direction to the district health authority's purchasing strategy. In the middle, the hospitals, the patients and the workers are suffering. That is the problem with the system.
In January 1990, the then Secretary of State for Health said:
Next year… we propose to reform the NHS: the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services".—[Official Report, 11 January 1990; Vol. 164, c. 1124.]
Where is the truth in that statement? It appears at column 1124 of the Official Report, for those who are interested in the facts.
For three years, we have constantly pointed out that the internal market reforms would mean the destruction of the national health service based on the principles of equity, universal access and comprehensiveness of service. 'Three years later, we have the cancelled operations, closed wards and cuts in services that the reforms have introduced. We have a two-tier health service, which is nothing to be proud of. A health service is emerging in which, if one chooses private care or one's GP is a fundholder, one is treated quicker than someone who goes to a non-fundholder—and massive waste, bureaucracy and a lack of planning pervade.
By contrast, the Government continually mislead the public about the crisis in the national health service. For example, a letter that was circulated in one of our hospitals states:
Theatre cancellation programme.
I am writing to inform you that the cancellation programme for January and February of 1994 has been delayed. The reason is the expected reduction in the workload to counteract the overachievement of contracts in some specialities. I apologise for the delay
in implementing the cancellation programme
and hope we will be able to finalise the programme shortly.
That is the stupidity and chaos of the present system.
The Government and their flagship authorities tell us that they are getting waiting lists down. An article in The Independent of 5 January 1994 states:
Mersey has become the first regional health authority in England to have no patient on the NHS waiting lists for more than a year.
We telephoned some GPs in Merseyside to find out what is going on. A letter circulated in January states:
The waiting lists for out-patient appointments for the spine clinic is now in excess of 18 months."—
wait for it—
The total appointment booking facility on the hospital computer system is only 18 months, therefore the computer facility is exhausted. All appointments will be allocated when appointments are available.
Yet the Government, through their good news unit, are encouraging the idea that there are no waiting lists of more than one year. That is not true.
Another patient received a letter in October 1993, advising the date of the first appointment—Thursday 5 January 1995. That is what is going on in the national health service under the Government.
The Government say that the health service needs more competition, but what has competition meant so far? We are now three years into the internal market and what do we have? We have a system in which money talks. If one's doctor happens to be a fundholder, one has more chance of being treated quickly.
It used to be that hospitals ran out of money and took only emergencies towards the end of the financial year. That is now happening at the start of the financial year. I have been told that some cash-strapped hospitals a:re desperate and are asking their consultants to seek out friends who might be fundholders. What does the Secretary of State have to say about that? She says that they are discovering more quickly that they cannot meet their commitments because they are more vigilant. They discover at the end of the year instead of at the beginning. Presumably that is what all the bureaucrats are doing.

Mr. Day: Will the hon. Lady give way?

Ms Primarolo: I have only 15 minutes.
The reforms have been about bringing the health service to the brink of privatisation. The interplay of the internal market, recent national policy changes and the activities of the private sector mean that the boundary between public and private health care is being blurred, so that soon—the Government hope—we will not be able to identify the boundary at all.
The number of people in Britain with private health care has grown. One out of nine people are now covered by private insurance, and GP fundholders have a financial incentive to encourage their patients to take insurance.

Mr. Day: Will the hon. Lady give way?

Ms Primarolo: No.
National health service income from private patients has soared by more than 30 per cent. in the first year of the reforms. Almost a quarter of the charges were accounted for by the first 57 hospitals. Of course, such hospitals are not taking private patients because they have exhausted their waiting lists. When they have no one to treat, they sit round idly waiting for the next patient to walk through the door. They turn to the private sector for work because the public sector cannot afford to pay for more patients to be treated. Waiting lists grow while the Government starve the NHS of money.
The National Health Service Management Executive actively encourages the investment of private capital in joint ventures in the NHS. In April this year, the Government relaxed the rules authorising capital spending, and the NHS Management executive is holding up schemes such as kidney dialysis, magnetic resonance imaging, staff accommodation, clinical waste incineration and patient hotels as examples of successful private investment. Naturally, the trusts and the private sector are delighted and are developing more joint ventures with enthusiasm.

Mrs. Bottomley: Excellent.

Ms Primarolo: The Secretary of State says "excellent". I am glad that she agrees with our analysis of the Government's interest in privatisation.

Mrs. Bottomley: Will the hon. Lady give way?

Ms Primarolo: Madam Deputy Speaker—[Interruption.]

Madam Deputy Speaker (Dame Janet Fookes): The House knows that if the speaker who has the floor does not choose to give way, other hon. Members must resume their seats.

Ms. Primarolo: The Secretary of State had 50 minutes.
I do not have all that time and I am required to sum up the debate.
The Government say that they are treating more patients. When I asked them how many patients were being treated in 1991 and 1992 by trusts, shadow trusts and directly held units, I was told in a written answer on 8 February 1993 that they did not collect the information and did not know. Dr. Ian Bogle, the chairman of the general medical services committee, describes the Government as undertaking a national cover-up, having a lack of honesty and living in Alice in Wonderland's world. I could not agree with him more.
We want to develop a national health service on the basis on which it was established and which the people of this country demand to see maintained—a high-quality public service that is paid for from central taxation and free at the point of delivery for all who need treatment. There will be no self-governing trusts or GP fundholders operating as private businesses in our national health service. There will be no need for gagging clauses restricting health workers from speaking out on the ground of commercial confidentiality.
We will provide a public health service, rather than an ill health service. Instead of creating poverty, unemployment and a health crisis, and then leaving the NHS to pick up the tab for poor health, we will promote health through co-ordinated action against poverty and inequality. We will

consult on the way to shape a national health service around those principles, and about how a Labour Government will fund that underfunding.
The British Medical Association said:
The council endorses the view that prioritising treatment on the basis of a purchaser's ability to fund that treatment, rather than on the basis of an objective assessment of relative clinical needs, infringes the ethical principle of equity and should be vigorously opposed.
We oppose the Government's privatisation of the NHS. We oppose their reforms, but not because we do not believe that the NHS needs improving and needs changing. It is a dynamic service which deals with people and needs to respond to people's needs. We believe that the Government's vision of the health service will not provide for the NHS. Therefore, we will continue to oppose their attempts—they have tried to do it since 1946—to destroy our NHS.

The Minister for Health (Dr. Brian Mawhinney): The hon. Member for Bristol, South (Ms Primarolo) pointed out that neither she nor I had much time to respond to today's debate, so I will take my lead from her.
I cannot ignore the speech by the hon. Member for Sheffield, Brightside (Mr. Blunkett). He pointed out that this was the first debate on the subject for a year, and that the Opposition had called it. After today's experience, I suspect that it will be a long time before the Opposition call another such debate. Indeed, so riveting was it for the Labour party that all of 34 Labour Members sat behind him as he delivered his scathing, vulgar and abusive attack on the Secretary of State.
The hon. Gentleman was unable to give, or to respond to questions and enunciate, any scintilla of Labour party policy. I thought for one moment that the hon. Member for Bristol, South had broken from cover and said something to do with policy. However, it was so ringed around with conditional clauses that I could see that she was entirely on a par with the hon. Member for Brightside.
He did say something, however, and I was interested that my hon. Friend the Member for Harlow (Mr. Hayes) picked up on it, as I did. This was the only policy that we have had from the Labour party tonight, and I want my hon. Friends to listen carefully. The hon. Gentleman said, "Our policies will have something to do with treating patients." I see that as being a big vote-getter around the country. My right hon. Friend the Secretary of State pointed out that that will be next month, or the month after, or the month after that.
I want to pick up on the comments of two hon. Gentleman who contributed to the debate. My hon. Friend the Member for Macclesfield (Mr. Winterton) encouraged us to listen to constructive criticism. We do that, but we are not interested in the mindless and ideologically based criticism that we have heard from the Opposition tonight. We are interested in constructive criticism. We recognise that, in a venture as large as the national health service, there are always ways to produce improvements, and we are always open to listen to constructive comments.
I heard what my hon. Friend said about community care. That it is a successful policy and helps frail elderly people enormously is agreed. It also helps people with mental illness, and I know that my hon. Friend is committed to them. I heard what he said about nurses and,


while I have always resisted the temptation to encourage colleagues to read speeches which I have made in the past, perhaps he will take the time to look at a speech I gave at the Royal College of Nursing congress in May 1993. He will find that I reflected exactly and in some greater detail the very point that he made earlier about the importance of creating space for nurses to care as a part of the professional discharge of their duties.
I would like to thank the hon. Member for Belfast, South (Rev. Martin Smyth) for his kind personal comments. My hon. Friend the Member for Broxbourne (Mrs. Roe) and my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) both recognised that it was important to increase funds to the NHS year on year, as we have done. My right hon. Friend pointed out that another £1·6 billion will go into the NHS during the next financial year. My hon. Friends pointed out that the way to maximise patient benefit from those resources was to improve management.
I was reminded of a comment made to me by a health authority chairman some time ago. He said that, when he was appointed four years ago, he inquired in his first week in office what the cost was for a hip replacement operation. Today, he says that he knows not only the cost of that operation, but the cost and quality of it in every single hospital in the area. He now knows that there is a sixfold difference in those costs. He is now able to manage the system in a manner that enables a better service to be presented to patients. My hon. Friend the Member for Chislehurst (Mr. Sims) also referred to that point.
The Labour motion expresses some concern about patient care. I know that the hon. Member for Brightside is extremely interested in beds. He issued a press statement—I read them all—on that matter on 10 January. I must admit that his press officer did not do an awfully good job, but, with reference to beds, that statement read:
The NHS is slowly being whittled away
I looked up the figures on the percentage reduction in the number of in-patient beds between 1979 to 1989. I discovered that, in this country, there has been a reduction of just more than 20 per cent. Spain, Greece, Portugal and the United States were in the 15 to 25 per cent. reduction band. The hon. Gentleman wiil be interested to know that even bigger reductions were made in Italy, Denmark and Ireland. Reductions were also made in Germany, France and the Netherlands.
The hon. Member for Brightside is probably incapable of getting his mind around those figures, but people outside the House will want to know why the number of beds available for health care is being reduced not only in this country but in every developed country in the world, except Belgium—I do not know why that is so. Let me give the hon. Gentleman the answer.
During the 1980s, the average length of stay in hospital was reduced from 10 days to six and a half days. In 1982, the average stay in hospital for someone receiving treatment for cataracts was eight days; today it is under three days, and many are treated as day patients. In the late 1970s, a person with a peptic ulcer would spend at least a week in hospital. Today, many patients do not go to hospital, because they are simply treated with drugs. The hon. Member for Brightside does not understand, will not understand and is incapable of understanding that, if the health system becomes more efficient, two things happen: more patients get treated and there is less demand for the hospital beds in which to treat them.
The hon. Gentleman will be interested to know that I visited the Enfield Community Care NHS trust on Monday. Members of the trust told me—I did not ask for or know the facts they simply gave them to me—that it is now treating nearly 20 per cent. more acute elderly in-patients, and that treatment costs have been reduced by 40 per cent. in the past three years. The average length of stay in the hospital has been halved. It has fewer acute beds and more doctors and nurses per acute patient. Those facts reflect what is happening in the health service throughout the country.
Instead of thanking the senior managers or the administrative staff of that trust for the job that they are doing, perhaps I should have said something in keeping with the speech by the hon. Member for Darlington (Mr. Milburn). Perhaps I should have said, "Ward clerks, the Labour party thinks that you are a waste of space. Medical secretaries, the Labour party wants you out. Wage clerks, the Labour party wants you on the dole. District nurses, no cars, the Labour party wants you on your bikes GPs on night calls, walk."
That is the sort of nonsense that flows from the ill-informed attacks by the Labour party on the management of the NHS, month in and month out. Do members of Unison think that they are being denigrated by Opposition spokesmen? Of course they do, because that is precisely what the Opposition have done in the debate.
I should like to draw the attention of the.hon. Member for Brightside to the North West Anglia hospital trust in Peterborough. It runs the best hospital-at-home scheme in the country. I am told that this year it will treat 635 patients, 435 of whom will be discharged early from hospital as a consequence of the scheme and another 160 who would otherwise have gone into hospital but can be treated at home.
May I give another example for the edification of the hon. Member for Brightside? Based on the national average, the length of stay in an acute hospital for hip replacement surgery is 15 days. In Peterborough it is six days in hospital and six days at home. The hospital-at-home scheme has reduced costs per case by 20 per cent., the length of stay in acute hospitals by 60 per cent., and the total length of the care episode by 20 per cent. We on this side of the House welcome that. It is good patient care and more patient care, but it makes no difference to the Opposition.
Under the last Labour Government, the number of patients treated increased by 1 per cent. a year. During the 1980s under this Government, the number increased by more than 2 per cent. a year. Since reforms were introduced in 1990, the number has increased by more than 5 per cent. a year—[interruption.] I understand that Labour Members do not like that.
Let me help the Opposition to understand it in a different way. That 1 per cent. a year under Labour represented 57,000 extra patients a year, whereas the 5 per cent. increase in the number of patients treated since the reforms represents 417,000 extra patients treated every year.
Let me put it another way for the Labour party. If I were to fill Wembley stadium on Monday night, Tuesday night, Wednesday night and Thursday night, and put more people in it on Friday night than ever watch Sheffield Wednesday or Sheffield United, all of them together would represent


the increase in the number of patients treated under this Government each year compared with the annual increase in the number treated under the last Labour Government.
Let me put it another way. Had we not changed the system that we inherited from the Labour party in 1979, more than 2,600,000 patients who received treatment would not have been treated. That number would fill Wembley stadium every night for a month. Those facts give a new meaning to that well known song, "We're on our way to Wembley."
This debate has illustrated, like no amount of Labour press releases could, the difference between each side of the House. The Labour party has no policies, whereas we have a co-ordinated patient-focused policy that is producing more patient care. They have a fixation with beds; we have a fixation with patients. They have a fixation with hospitals; we have a fixation with patient care.
I call on my hon. Friends to recognise that, in every football ground in the country, people are singing our praises because they realise that we are on our way to Wembley in terms of the number of patients that we have treated. I urge my hon. Friends to throw out the Opposition motion and support the Government's policy.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 265, Noes 311.

Division No. 85]
[10 pm


AYES


Abbott, Ms Diane
Chisholm, Malcolm


Adams, Mrs Irene
Clapham, Michael


Ainger, Nick
Clarke, Eric (Midlothian)


Ainsworth, Robert (Cov'try NE)
Clarke, Tom (Monklands W)


Allen, Graham
Clelland, David


Alton, David
Clwyd, Mrs Ann


Anderson, Donald (Swansea E)
Coffey, Ann


Anderson, Ms Janet (Ros'dale)
Cohen, Harry


Armstrong, Hilary
Connarty, Michael


Ashton, Joe
Cook, Frank (Stockton N)


Austin-Walker, John
Corbett, Robin


Banks, Tony (Newham NW)
Corbyn, Jeremy


Barnes, Harry
Cousins, Jim


Battle, John
Cox, Tom


Bayley, Hugh
Cryer, Bob


Beckett, Rt Hon Margaret
Cummings, John


Bell, Stuart
Cunliffe, Lawrence


Benn, Rt Hon Tony
Cunningham, Jim (Covy SE)


Bennett, Andrew F.
Cunningham, Rt Hon Dr John


Benton, Joe
Darling, Alistair


Bermingham, Gerald
Davidson, Ian


Berry, Dr. Roger
Davies, Bryan (Oldham C'tral)


Betts, Clive
Davies, Rt Hon Denzil (Llanelli)


Blair, Tony
Davies, Ron (Caerphilly)


Blunkett, David
Davis, Terry (B'ham, H'dge H'l)


Boateng, Paul
Denham, John


Boyes, Roland
Dewar, Donald


Bradley, Keith
Dixon, Don


Bray, Dr Jeremy
Dobson, Frank


Brown, Gordon (Dunfermline E)
Donohoe, Brian H.


Brown, N. (N'c'tle upon Tyne E)
Dowd, Jim


Bruce, Malcolm (Gordon)
Dunnachie, Jimmy


Burden, Richard
Dunwoody, Mrs Gwyneth


Byers, Stephen
Eagle, Ms Angela


Caborn, Richard
Eastham, Ken


Callaghan, Jim
Enright, Derek


Campbell, Mrs Anne (C'bridge)
Etherington, Bill


Campbell, Menzies (Fife NE)
Evans, John (St Helens N)


Campbell, Ronnie (Blyth V)
Ewing, Mrs Margaret


Campbell-Savours, D. N.
Fatchett, Derek


Canavan, Dennis
Faulds, Andrew


Cann, Jamie
Field, Frank (Birkenhead)





Fisher, Mark
McNamara, Kevin


Flynn, Paul
McWilliam, John


Foster, Rt Hon Derek
Madden, Max


Foulkes, George
Mahon, Alice


Fraser, John
Mandelson, Peter


Fyfe, Maria
Marek, Dr John


Galloway, George
Marshall, David (Shettleston)


Gapes, Mike
Marshall, Jim (Leicester, S)


Garrett, John
Martin, Michael J. (Springburn)


George, Bruce
Martlew, Eric


Gerrard, Neil
Maxton, John


Gilbert, Rt Hon Dr John
Meacher, Michael


Godman, Dr Norman A.
Meale, Alan


Godsiff, Roger
Michael, Alun


Golding, Mrs Llin
Michie, Bill (Sheffield Heeley)


Gordon, Mildred
Milburn, Alan


Gould, Bryan
Miller, Andrew


Graham, Thomas
Mitchell, Austin (Gt Grimsby)


Grant, Bernie (Tottenham)
Moonie, Dr Lewis


Griffiths, Nigel (Edinburgh S)
Morgan, Rhodri


Griffiths, Win (Bridgend)
Moriey, Elliot


Grocott, Bruce
Morris, Rt Hon A. (Wy'nshawe)


Gunnell, John
Morris, Rt Hon J. (Aberavon)


Hain, Peter
Mowlam, Marjorie


Hall, Mike
Mudie, George


Hanson, David
Mullin, Chris


Hardy, Peter
Murphy, Paul


Harman, Ms Harriet
O'Brien, Michael (N W'kshire)


Hattersley, Rt Hon Roy
O'Brien, William (Normanton)


Henderson, Doug
O'Hara, Edward


Hendron, Dr Joe
Olner, William


Heppell, John
O'Neill, Martin


Hill, Keith (Streatham)
Orme, Rt Hon Stanley


Hinchliffe, David
Paisley, Rev Ian


Hoey, Kate
Parry, Robert


Hogg, Norman (Cumbernauld)
Patchett, Terry


Home Robertson, John
Pendry, Tom


Hood, Jimmy
Pickthall, Colin


Hoon, Geoffrey
Pike, Peter L.


Howarth, George (Knowsley N)
Pope, Greg


Howells, Dr. Kim (Pontypridd)
Powell, Ray (Ogmore)


Hoyle, Doug
Prentice, Ms Bridget (Lew'm E)


Hughes, Kevin (Doncaster N)
Prentice, Gordon (Pendle)


Hughes, Roy (Newport E)
Prescott, John


Hughes, Simon (Southwark)
Primarolo, Dawn


Hume, John
Purchase, Ken


Hutton, John
Quin, Ms Joyce


Illsley, Eric
Radice, Giles


Ingram, Adam
Randall, Stuart


Jackson, Glenda (H'stead)
Raynsford, Nick


Jackson, Helen (Shef'ld, H)
Redmond, Martin


Jamieson, David
Reid, Dr John


Janner, Greville
Rendel, David


Jones, Barry (Alyn and D'side)
Richardson, Jo


Jones, Jon Owen (Cardiff C)
Robertson, George (Hamilton)


Jones, Lynne (B'ham S O)
Robinson, Geoffrey (Co'tryNW)


Jones, Martyn (Clwyd, SW)
Roche, Mrs. Barbara


Jowell, Tessa
Rogers, Allan


Keen, Alan
Rooker, Jeff


Kennedy, Jane (Lpool Brdgn)
Rooney, Terry


Khabra, Piara S.
Ross, Ernie (Dundee W)


Kilfedder, Sir James
Rowlands, Ted


Kinnock, Rt Hon Neil (Islwyn)
Ruddock, Joan


Leighton, Ron
Sedgemore, Brian


Lewis, Terry
Sheldon, Rt Hon Robert


Litheriand, Robert
Shore, Rt Hon Peter


Livingstone, Ken
Short, Clare


Lloyd, Tony (Stretford)
Simpson, Alan


Llwyd, Elfyn
Skinner, Dennis


Lynne, Ms Liz
Smith, Andrew (Oxford E)


McAllion, John
Smith, C. (Isl'ton S & F'sbury)


McAvoy, Thomas
Smith, Rt Hon John (M'kl'ds E)


McCartney, Ian
Smith, Llew (Blaenau Gwent)


Macdonald, Calum
Soley, Clive


McFall, John
Spearing, Nigel


McKelvey, William
Spellar, John


Mackinlay, Andrew
Squire, Rachel (Dunfermline W)


McLeish, Henry
Steinberg, Gerry


Maclennan, Robert
Stevenson, George


McMaster, Gordon
Stott, Roger






Straw, Jack
Williams, Alan W (Carmarthen)


Taylor, Mrs Ann (Dewsbury)
Wilson, Brian


Tipping, Paddy
Winnick, David


Turner, Dennis
Wise, Audrey


Vaz, Keith
Worthington, Tony


Walker, Rt Hon Sir Harold
Wray, Jimmy


Walley, Joan
Wright, Dr Tony


Wardell, Gareth (Gower)
Young, David (Bolton SE)


Wareing, Robert N



Watson, Mike
Tellers for the Ayes:


Welsh, Andrew
Mr. Peter Kilfoyle, and Mr. Jack Thompson.


Wicks, Malcolm



Williams, Rt Hon Alan (Sw'n W)





NOES


Ainsworth, Peter (East Surrey)
Davies, Quentin (Stamford)


Aitken, Jonathan
Davis, David (Boothferry)


Alexander, Richard
Day, Stephen


Alison, Rt Hon Michael (Selby)
Deva, Nirj Joseph


Allason, Rupert (Torbay)
Devlin, Tim


Amess, David
Dickens, Geoffrey


Ancram, Michael
Dicks, Terry


Arbuthnot, James
Dorrell, Stephen


Arnold, Jacques (Gravesham)
Douglas-Hamilton, Lord James


Aspinwall, Jack
Dover, Den


Atkins, Robert
Duncan, Alan


Atkinson, David (Bour'mouth E)
Duncan-Smith, Iain


Atkinson, Peter (Hexham)
Dunn, Bob


Baker, Nicholas (Dorset North)
Durant, Sir Anthony


Baldry, Tony
Dykes, Hugh


Banks, Matthew (Southport)
Eggar, Tim


Banks, Robert (Harrogate)
Elletson, Harold


Bates, Michael
Emery, Rt Hon Sir Peter


Batiste, Spencer
Evans, David (Welwyn Hatfield)


Bellingham, Henry
Evans, Jonathan (Brecon)


Bendall, Vivian
Evans, Nigel (Ribble Valley)


Beresford, Sir Paul
Evans, Roger (Monmouth)


Biffen, Rt Hon John
Evennett, David


Blackburn, Dr John G.
Faber, David


Body, Sir Richard
Fabricant, Michael


Bonsor, Sir Nicholas
Fairbairn, Sir Nicholas


Booth, Hartley
Fenner, Dame Peggy


Boswell, Tim
Field, Barry (Isle of Wight)


Bottomley, Rt Hon Virginia
Fishburn, Dudley


Bowden, Andrew
Forman, Nigel


Bowis, John
Forsyth, Michael (Stirling)


Boyson, Rt Hon Sir Rhodes
Forth, Eric


Brandreth, Gyles
Fox, Dr Liam (Woodspring)


Brazier, Julian
Fox, Sir Marcus (Shipley)


Bright, Graham
Freeman, Rt Hon Roger


Brooke, Rt Hon Peter
French, Douglas


Brown, M. (Brigg & Cl'thorpes)
Fry, Sir Peter


Browning, Mrs. Angela
Gale, Roger


Bruce, Ian (S Dorset)
Gallie, Phil


Budgen, Nicholas
Gardiner, Sir George


Burns, Simon
Garel-Jones, Rt Hon Tristan


Burl, Alistair
Garnier, Edward


Butler, Peter
Gill, Christopher


Butterfill, John
Gillan, Cheryl


Carlisle, John (Luton North)
Goodlad, Rt Hon Alastair


Carlisle, Kenneth (Lincoln)
Goodson-Wickes, Dr Charles


Carrington, Matthew
Gorman, Mrs Teresa


Cash, William
Gorst, John


Channon, Rt Hon Paul
Grant, Sir A. (Cambs SW)


Churchill, Mr
Greenway, Harry (Ealing N)


Clappison, James
Greenway, John (Ryedale)


Clark, Dr Michael (Rochford)
Griffiths, Peter (Portsmouth, N)


Clarke, Rt Hon Kenneth (Ruclif)
Grylls, Sir Michael


Clifton-Brown, Geoffrey
Gummer, Rt Hon John Selwyn


Coe, Sebastian
Hague, William


Colvin, Michael
Hamilton, Rt Hon Sir Archie


Congdon, David
Hamilton, Neil (Tatton)


Conway, Derek
Hampson, Dr Keith


Coombs, Anthony (Wyre For'st)
Hanley, Jeremy


Coombs, Simon (Swindon)
Hannam, Sir John


Cope, Rt Hon Sir John
Hargreaves, Andrew


Couchman, James
Harris, David


Cran, James
Haselhurst, Alan


Currie, Mrs Edwina (S D'by'ire)
Hawkins, Nick


Curry, David (Skipton & Ripon)
Hawksley, Warren





Hayes, Jerry
Nicholls, Patrick


Heald, Oliver
Nicholson, David (Taunton)


Heath, Rt Hon Sir Edward
Nicholson, Emma (Devon West)


Heathcoat-Amory, David
Norris, Steve


Hendry, Charles
Onslow, Rt Hon Sir Cranley


Heseltine, Rt Hon Michael
Oppenheim, Phillip


Hicks, Robert
Ottaway, Richard


Higgins, Rt Hon Sir Terence L.
Page, Richard


Hill, James (Southampton Test)
Paice, James


Hogg, Rt Hon Douglas (G'tham)
Patnick, Irvine


Horam, John
Patten, Rt Hon John


Hordern, Rt Hon Sir Peter
Pattie, Rt Hon Sir Geoffrey


Howard, Rt Hon Michael
Pawsey, James


Howarth, Alan (Strafrd-on-A)
Peacock, Mrs Elizabeth


Howell, Rt Hon David (G'dford)
Pickles, Eric


Howell, Sir Ralph (N Norfolk)
Porter, Barry (Wirral S)


Hughes Robert G. (Harrow W)
Portillo, Rt Hon Michael


Hunt, Rt Hon David (Wirral W)
Powell, William (Corby)


Hunt, Sir John (Ravensbourne)
Rathbone, Tim


Hunter, Andrew
Redwood, Rt Hon John


Jack, Michael
Renton, Rt Hon Tim


Jackson, Robert (Wantage)
Richards, Rod


Jenkin, Bernard
Riddick, Graham


Jessel, Toby
Robathan, Andrew


Johnson Smith, Sir Geoffrey
Roberts, Rt Hon Sir Wyn


Jones, Robert B. (W Hertfdshr)
Robertson, Raymond (Ab'd'n S)


Jopling, Rt Hon Michael
Robinson, Mark (Somerton)


Kellett-Bowman, Dame Elaine
Roe, Mrs Marion (Broxbourne)


Key, Robert
Rowe, Andrew (Mid Kent)


King, Rt Hon Tom
Rumbold, Rt Hon Dame Angela


Kirkhope, Timothy
Ryder, Rt Hon Richard


Knapman, Roger
Sackville, Tom


Knight, Mrs Angela (Erewash)
Sainsbury, Rt Hon Tim


Knight, Greg (Derby N)
Scott, Rt Hon Nicholas


Knight, Dame Jill (Bir'm E'st'n)
Shaw, David (Dover)


Knox, Sir David
Shaw, Sir Giles (Pudsey)


Kynoch, George (Kincardine)
Shephard, Rt Hon Gillian


Lait, Mrs Jacqui
Shepherd, Richard (Aldridge)


Lamont, Rt Hon Norman
Shersby, Michael


Lang, Rt Hon Ian
Sims, Roger


Lawrence, Sir Ivan
Skeet, Sir Trevor


Legg, Barry
Smith, Sir Dudley (Warwick)


Leigh, Edward
Smith, Tim (Beaconsfield)


Lennox-Boyd, Mark
Soames, Nicholas


Lester, Jim (Broxtowe)
Speed, Sir Keith


Lidington, David
Spencer, Sir Derek


Lilley, Rt Hon Peter
Spicer, Sir James (W Dorset)


Lloyd, Rt Hon Peter (Fareham)
Spicer, Michael (S Worcs)


Luff, Peter
Spink, Dr Robert


MacGregor, Rt Hon John
Spring, Richard


MacKay, Andrew
Sproat, Iain


Maclean, David
Squire, Robin (Hornchurch)


McLoughlin, Patrick
Stanley, Rt Hon Sir John


McNair-Wilson, Sir Patrick
Steen, Anthony


Madel, Sir David
Stephen, Michael


Maitland, Lady Olga
Stern, Michael


Malone, Gerald
Stewart, Allan


Mans, Keith
Streeter, Gary


Marland, Paul
Sumberg, David


Marlow, Tony
Sweeney, Walter


Marshall, John (Hendon S)
Sykes, John


Marshall, Sir Michael (Arundel)
Tapsell, Sir Peter


Martin, David (Portsmouth S)
Taylor, Ian (Esher)


Mates, Michael
Taylor, John M. (Solihull)


Mawhinney, Rt Hon Dr Brian
Taylor, Sir Teddy (Southend, E)


Mayhew, Rt Hon Sir Patrick
Temple-Morris, Peter


Mellor, Rt Hon David
Thomason, Roy


Merchant, Piers
Thompson, Sir Donald (C'er V)


Milligan, Stephen
Thompson, Patrick (Norwich N)


Mills, Iain
Thumham, Peter


Mitchell, Andrew (Gedling)
Townend, John (Bridlington)


Mitchell, Sir David (Hants NW)
Townsend, Cyril D. (Bexl'yh'th)


Moate, Sir Roger
Tracey, Richard


Monro, Sir Hector
Tredinnick, David


Montgomery, Sir Fergus
Trend, Michael


Moss, Malcolm
Trotter, Neville


Needham, Richard
Twinn, Dr Ian


Nelson, Anthony
Vaughan, Sir Gerard


Neubert, Sir Michael
Viggers, Peter


Newton, Rt Hon Tony
Waldegrave, Rt Hon William






Walden, George
Willetts, David


Waller, Gary
Wilshire, David


Ward, John
Winterton, Mrs Ann (Congleton)


Wardle, Charles (Bexhill)
Winterton, Nicholas (Macc'f'ld)


Waterson, Nigel
Wolfson, Mark


Watts, John
Wood, Timothy


Wells, Bowen
Yeo, Tim


Wheeler, Rt Hon Sir John
Young, Rt Hon Sir George


Whitney, Ray



Whittingdale, John
Tellers for the Noes:


Widdecombe, Ann
Mr. David Lightbown and Mr. Sydney Chapman.


Wiggin, Sir Jerry



Wilkinson, John

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments):—

The House divided: Ayes 309, Noes 264.

Division No. 86]
[10.15 pm


AYES


Ainsworth, Peter (East Surrey)
Coombs, Simon (Swindon)


Aitken, Jonathan
Cope, Rt Hon Sir John


Alexander, Richard
Couchman, James


Alison, Rt Hon Michael (Selby)
Cran, James


Allason, Rupert (Torbay)
Currie, Mrs Edwina (S D'by'ire)


Amess, David
Curry, David (Skipton & Ripon)


Ancram, Michael
Davies, Quentin (Stamford)


Arbuthnot, James
Davis, David (Boothferry)


Arnold, Jacques (Gravesham)
Day, Stephen


Aspinwall, Jack
Deva, Nirj Joseph


Atkins, Robert
Devlin, Tim


Atkinson, David (Bour'mouth E)
Dickens, Geoffrey


Atkinson, Peter (Hexham)
Dicks, Terry


Baker, Nicholas (Dorset North)
Dorrell, Stephen


Baldry, Tony
Douglas-Hamilton, Lord James


Banks, Matthew (Southport)
Dover, Den


Banks, Robert (Harrogate)
Duncan, Alan


Bates, Michael
Duncan-Smith, Iain


Batiste, Spencer
Dunn, Bob


Bellingham, Henry
Durant, Sir Anthony


Bendall, Vivian
Dykes, Hugh


Beresford, Sir Paul
Eggar, Tim


Biffen, Rt Hon John
Elletson, Harold


Blackburn, Dr John G.
Emery, Rt Hon Sir Peter


Body, Sir Richard
Evans, David (Welwyn Hatfield)


Bonsor, Sir Nicholas
Evans, Jonathan (Brecon)


Booth, Hartley
Evans, Nigel (Ribble Valley)


Boswell, Tim
Evans, Roger (Monmouth)


Bottomley, Rt Hon Virginia
Evennett, David


Bowden, Andrew
Faber, David


Bowis, John
Fabricant, Michael


Boyson, Rt Hon Sir Rhodes
Fairbairn, Sir Nicholas


Brandreth, Gyles
Fenner, Dame Peggy


Brazier, Julian
Field, Barry (Isle of Wight)


Bright, Graham
Fishburn, Dudley


Brooke, Rt Hon Peter
Forman, Nigel


Brown, M. (Brigg & Cl'thorpes)
Forsyth, Michael (Stirling)


Browning, Mrs. Angela
Forth, Eric


Bruce, Ian (S Dorset)
Fox, Dr Liam (Woodspring)


Budgen, Nicholas
Fox, Sir Marcus (Shipley)


Burns, Simon
Freeman, Rt Hon Roger


Burt, Alistair
French, Douglas


Butler, Peter
Fry, Sir Peter


Butterfill, John
Gale, Roger


Carlisle, John (Luton North)
Gallie, Phil


Carlisle, Kenneth (Lincoln)
Gardiner, Sir George


Carrington, Matthew
Garel-Jones, Rt Hon Tristan


Cash, William
Garnier, Edward


Channon, Rt Hon Paul
Gill, Christopher


Churchill, Mr
Gillan, Cheryl


Clappison, James
Goodlad, Rt Hon Alastair


Clark, Dr Michael (Rochford)
Goodson-Wickes, Dr Charles


Clarke, Rt Hon Kenneth (Ruclif)
Gorman, Mrs Teresa


Clifton-Brown, Geoffrey
Gorst, John


Coe, Sebastian
Grant, Sir A. (Cambs SW)


Congdon, David
Greenway, Harry (Ealing N)


Conway, Derek
Greenway, John (Ryedale)


Coombs, Anthony (Wyre For'st)
Griffiths, Peter (Portsmouth, N)





Grytls, Sir Michael
Mellor, Rt Hon David


Gummer, Rt Hon John Selwyn
Merchant, Piers


Hague, William
Milligan, Stephen


Hamilton, Rt Hon Sir Archie
Mills, Iain


Hamilton, Neil (Tatton)
Mitchell, Andrew (Gedling)


Hampson, Dr Keith
Mitchell, Sir David (Hants NW)


Hanley, Jeremy
Moate, Sir Roger


Hannam, Sir John
Monro, Sir Hector


Hargreaves, Andrew
Montgomery, Sir Fergus


Harris, David
Moss, Malcolm


Haselhurst, Alan
Needham, Richard


Hawkins, Nick
Nelson, Anthony


Hawksley, Warren
Neubert, Sir Michael


Hayes, Jerry
Newton, Rt Hon Tony


Heald, Oliver
Nicholls, Patrick


Heath, Rt Hon Sir Edward
Nicholson, David (Taunton)


Heathcoat-Amory, David
Nicholson, Emma (Devon West)


Hendry, Charles
Norris, Steve


Heseltine, Rt Hon Michael
Onslow, Rt Hon Sir Cranley


Hicks, Robert
Oppenheim, Phillip


Higgins, Rt Hon Sir Terence L.
Ottaway, Richard


Hill, James (Southampton Test)
Page, Richard


Hogg, Rt Hon Douglas (G'tham)
Paice, James


Horam, John
Patten, Rt Hon John


Hordem, Rt Hon Sir Peter
Pattie, Rt Hon Sir Geoffrey


Howard, Rt Hon Michael
Pawsey, James


Howarth, Alan (Strat'rd-on-A)
Peacock, Mrs Elizabeth


Howell, Rt Hon David (G'dford)
Pickles, Eric


Howell, Sir Ralph (N Norfolk)
Porter, Barry (Wirral S)


Hughes Robert G. (Harrow W)
Portillo, Rt Hon Michael


Hunt, Rt Hon David (Wirral W)
Powell, William (Corby)


Hunt, Sir John (Ravensbourne)
Rathbone, Tim


Hunter, Andrew
Redwood, Rt Hon John


Jack, Michael
Renton, Rt Hon Tim


Jackson, Robert (Wantage)
Richards, Rod


Jenkin, Bernard
Riddick, Graham


Jessel, Toby
Robathan, Andrew


Johnson Smith, Sir Geoffrey
Roberts, Rt Hon Sir Wyn


Jones, Robert B. (W Hertfdshr)
Robertson, Raymond (Ab'd'n S)


Jopling, Rt Hon Michael
Robinson, Mark (Somerton)


Kellett-Bowman, Dame Elaine
Roe, Mrs Marion (Broxbourne)


Key, Robert
Rowe, Andrew (Mid Kent)


King, Rt Hon Tom
Rumbold, Rt Hon Dame Angela


Kirkhope, Timothy
Ryder, Rt Hon Richard


Knapman, Roger
Sackville, Tom


Knight, Mrs Angela (Erewash)
Sainsbury, Rt Hon Tim


Knight, Greg (Derby N)
Scott, Rt Hon Nicholas


Knight, Dame Jill (Bir'm E'sfn)
Shaw, David (Dover)


Knox, Sir David
Shaw, Sir Giles (Pudsey)


Kynoch, George (Kincardine)
Shephard, Rt Hon Gillian


Lait, Mrs Jacqui
Shepherd, Richard (Aldridge)


Lamont, Rt Hon Norman
Shersby, Michael


Lang, Rt Hon Ian
Sims, Roger


Lawrence, Sir Ivan
Skeet, Sir Trevor


Legg, Barry
Smith, Sir Dudley (Warwick)


Leigh, Edward
Smith, Tim (Beaconsfield)


Lennox-Boyd, Mark
Soames, Nicholas


Lester, Jim (Broxtowe)
Speed, Sir Keith


Lidington, David
Spencer, Sir Derek


Lightbown, David
Spicer, Sir James (W Dorset)


Lilley, Rt Hon Peter
Spicer, Michael (S Worcs)


Lloyd, Rt Hon Peter (Fareham)
Spink, Dr Robert


Luff, Peter
Spring, Richard


MacGregor, Rt Hon John
Sproat, Iain


MacKay, Andrew
Squire, Robin (Hornchurch)


Maclean, David
Stanley, Rt Hon Sir John


McLoughlin, Patrick
Steen, Anthony


McNair-Wilson, Sir Patrick
Stephen, Michael


Madel, Sir David
Stern, Michael


Maitland, Lady Olga
Stewart, Allan


Malone, Gerald
Streeter, Gary


Mans, Keith
Sumberg, David


Marland, Paul
Sweeney, Walter


Marlow, Tony
Sykes, John


Marshall, John (Hendon S)
Tapsell, Sir Peter


Marshall, Sir Michael (Arundel)
Taylor, Ian (Esher)


Martin, David (Portsmouth S)
Taylor, John M. (Solihull)


Mates, Michael
Taylor, Sir Teddy (Southend, E)


Mawhinney, Rt Hon Dr Brian
Temple-Morris, Peter


Mayhew, Rt Hon Sir Patrick
Thomason, Roy






Thompson, Sir Donald (C'er V)
Wheeler, Rt Hon Sir John


Thompson, Patrick (Norwich N)
Whitney, Ray


Thurnham, Peter
Whittingdale, John


Townsend, Cyril D. (Bexl'yh'th)
Widdecombe, Ann


Tracey, Richard
Wiggin, Sir Jerry


Tredinnick, David
Wilkinson, John


Trend, Michael
Willetts, David


Trotter, Neville
Wilshire, David


Twinn, Dr Ian
Winterton, Mrs Ann (Congleton)


Vaughan, Sir Gerard
Winterton, Nicholas (Macc'f'ld)


Viggers, Peter
Wolfson, Mark


Waldegrave, Rt Hon William
Wood, Timothy


Walden, George
Yeo, Tim


Waller, Gary
Young, Rt Hon Sir George


Ward, John



Wardle, Charles (Bexhill)
Tellers for the Ayes:


Waterson, Nigel
Mr. Sydney Chapman and Mr. Irvine Patnick.


Watts, John



Wells, Bowen





NOES


Abbott, Ms Diane
Cunningham, Jim (Covy SE)


Adams, Mrs Irene
Cunningham, Rt Hon Dr John


Ainger, Nick
Darling, Alistair


Ainsworth, Robert (Cov'try NE)
Davidson, Ian


Allen, Graham
Davies, Bryan (Oldham C'tral)


Alton, David
Davies, Rt Hon Denzil (Llanelli)


Anderson, Donald (Swansea E)
Davies, Ron (Caerphilly)


Anderson, Ms Janet (Ros'dale)
Davis, Terry (B'ham, H'dge H'l)


Armstrong, Hilary
Denham, John


Ashton, Joe
Dewar, Donald


Austin-Walker, John
Dixon, Don


Banks, Tony (Newham NW)
Dobson, Frank


Barnes, Harry
Donohoe, Brian H.


Battle, John
Dowd, Jim


Bayley, Hugh
Dunnachie, Jimmy


Beckett, Rt Hon Margaret
Dunwoody, Mrs Gwyneth


Bell, Stuart
Eagle, Ms Angela


Benn, Rt Hon Tony
Eastham, Ken


Bennett, Andrew F.
Enright, Derek


Benton, Joe
Etherington, Bill


Bermingham, Gerald
Evans, John (St Helens N)


Berry, Dr. Roger
Ewing, Mrs Margaret


Betts, Clive
Fatchett, Derek


Blair, Tony
Faulds, Andrew


Blunkett, David
Field, Frank (Birkenhead)


Boateng, Paul
Fisher, Mark


Boyes, Roland
Flynn, Paul


Bradley, Keith
Foster, Rt Hon Derek


Bray, Dr Jeremy
Foulkes, George


Brown, Gordon (Dunfermline E)
Fraser, John


Brown, N. (N'c'tle upon Tyne E)
Fyfe, Maria


Bruce, Malcolm (Gordon)
Galloway, George


Burden, Richard
Gapes, Mike


Byers, Stephen
Garrett, John


Caborn, Richard
George, Bruce


Callaghan, Jim
Gerrard, Neil


Campbell, Mrs Anne (C'bridge)
Gilbert, Rt Hon Dr John


Campbell, Menzies (Fife NE)
Godman, Dr Norman A.


Campbell, Ronnie (Blyth V)
Godsiff, Roger


Campbell-Savours, D. N.
Golding, Mrs Llin


Canavan, Dennis
Gordon, Mildred


Cann, Jamie
Gould, Bryan


Chisholm, Malcolm
Graham, Thomas


Clapham, Michael
Grant, Bernie (Tottenham)


Clarke, Eric (Midlothian)
Griffiths, Nigel (Edinburgh S)


Clarke, Tom (Monklands W)
Griffiths, Win (Bridgend)


Clelland, David
Grocott, Bruce


Clwyd, Mrs Ann
Gunnell, John


Coffey, Ann
Hain, Peter


Cohen, Harry
Hall, Mike


Connarty, Michael
Hanson, David


Cook, Frank (Stockton N)
Hardy, Peter


Corbett, Robin
Harman, Ms Harriet


Corbyn, Jeremy
Hattersley, Rt Hon Roy


Cousins, Jim
Henderson, Doug


Cox, Tom
Hendron, Dr Joe


Cryer, Bob
Heppell, John


Cummings, John
Hill, Keith (Streatham)


Cunliffe, Lawrence
Hinchliffe, David





Hoey, Kate
O'Hara, Edward


Hogg, Norman (Cumbernauld)
Olner, William


Home Robertson, John
O'Neill, Martin


Hood, Jimmy
Orme, Rt Hon Stanley


Hoon, Geoffrey
Paisley, Rev Ian


Howarth, George (Knowsley N)
Parry, Robert


Howells, Dr. Kim (Pontypridd)
Patchett, Terry


Hoyle, Doug
Pendry, Tom


Hughes, Kevin (Doncaster N)
Pickthall, Colin


Hughes, Roy (Newport E)
Pike, Peter L.


Hughes, Simon (Southwark)
Pope, Greg


Hume, John
Powell, Ray (Ogmore)


Hutton, John
Prentice, Ms Bridget (Lew'm E)


Illsley, Eric
Prentice, Gordon (Pendle)


Ingram, Adam
Prescott, John


Jackson, Glenda (H'stead)
Primarolo, Dawn


Jackson, Helen (Shef'ld, H)
Purchase, Ken


Jamieson, David
Quin, Ms Joyce


Janner, Greville
Radice, Giles


Jones, Barry (Alyn and D'side)
Randall, Stuart


Jones, Jon Owen (Cardiff C)
Raynsford, Nick


Jones, Lynne (B'ham S O)
Redmond, Martin


Jones, Martyn (Clwyd, SW)
Reid, Dr John


Jowell, Tessa
Rendel, David


Keen, Alan
Richardson, Jo


Kennedy, Jane (Lpool Brdgn)
Robertson, George (Hamilton)


Khabra, Piara S.
Robinson, Geoffrey (Co'try NW)


Kilfedder, Sir James
Roche, Mrs. Barbara


Kinnock, Rt Hon Neil (Islwyn)
Rogers, Allan


Leighton, Ron
Rooker, Jeff


Lewis, Terry
Rooney, Terry


Litherland, Robert
Ross, Ernie (Dundee W)


Livingstone, Ken
Rowlands, Ted


Lloyd, Tony (Stretford)
Ruddock, Joan


Llwyd, Elfyn
Sedgemore, Brian


Lynne, Ms Liz
Sheldon, Rt Hon Robert


McAllion, John
Short, Clare


McAvoy, Thomas
Simpson, Alan


McCartney, Ian
Skinner, Dennis


Macdonald, Calum
Smith, Andrew (Oxford E)


McFall, John
Smith, C. (Isl'ton S & F'sbury)


McKelvey, William
Smith, Rt Hon John (M'kl'ds E)


Mackinlay, Andrew
Smith, Llew (Blaenau Gwent)


McLeish, Henry
Soley, Clive


Maclennan, Robert
Spearing, Nigel


McMaster, Gordon
Spellar, John


McNamara, Kevin
Squire, Rachel (Dunfermline W)


McWilliam, John
Steinberg, Gerry


Madden, Max
Stevenson, George


Mahon, Alice
Stott, Roger


Mandelson, Peter
Straw, Jack


Marek, Dr John
Taylor, Mrs Ann (Dewsbury)


Marshall, David (Shettleston)
Tipping, Paddy


Marshall, Jim (Leicester, S)
Turner, Dennis


Martin, Michael J. (Springburn)
Vaz, Keith


Martlew, Eric
Walker, Rt Hon Sir Harold


Maxton, John
Walley, Joan


Meacher, Michael
Wardell, Gareth (Gower)


Meale, Alan
Wareing, Robert N


Michael, Alun
Watson, Mike


Michie, Bill (Sheffield Heeley)
Welsh, Andrew


Milburn, Alan
Wicks, Malcolm


Miller, Andrew
Williams, Rt Hon Alan (Sw'n W)


Mitchell, Austin (Gt GrimsBy)
Williams, Alan W (Carmarthen)


Moonie, Dr Lewis
Wilson, Brian


Morgan, Rhodri
Winnick, David


Morley, Elliot
Wise, Audrey


Morris, Rt Hon A. (Wy'nshawe)
Worthington, Tony


Morris, Rt Hon J. (Aberavon)
Wray, Jimmy


Mowlam, Marjorie
Wright, Dr Tony


Mudie, George
Young, David (Bolton SE)


Mullin, Chris



Murphy, Paul
Tellers for the Noes:


O'Brien, Michael (N W'kshire)
Mr. Peter Kilfoyle and Mr. Jack Thompson.


O'Brien, William (Normanton)

Question accordingly agreed to.

MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,


That this House welcomes the improvement in the efficiency of the National Health Service which has resulted in a substantial increase in the number of patients treated, a reduction in long waiting times for hospital treatment and improvements in the quality of patient care; considers that these improvements show that the health reforms are working and that accountability has been strengthened by the clarification of responsibilities under those reforms; and looks forward to further benefits for patients resulting from proposals announced by the Secretary of State for Health to minimise the costs of administration through the proposed abolition of regional health authorities and streamlining of management.

Staff (Transport)

Mr. Bob Cryer: On a point of order, Mr. Deputy Speaker. It has concerned me for some time that there is an archaic rule whereby, if the Adjournment debate starts before 10.30 pm, transport is not provided for staff although they might not leave the House until 11 pm or after. I understand that a Standing Committee is sitting tonight so that transport will be provided, but I am sure you will appreciate that to have to travel by tube or bus at 11 pm or later, and often for more than an hour, is not a pleasant prospect.
I therefore wonder whether you, Mr. Deputy Speaker, would refer the matter to the relevant Committee to see whether the arbitrary rule according to which staff are denied transport for the sake of a few seconds can be changed to ensure that staff are properly catered for, as there is no doubt that it can be dangerous to travel on public transport late at night.

Mr. Dennis Skinner: Further to that point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker (Mr. Michael Morris): Is it on the same subject?

Mr. Skinner: Yes. My hon. Friend the Member for Bradford, South (Mr. Cryer) has raised this matter several times and has received some assistance from our Whips Office. When we have two votes, as we had tonight, they take until almost 10.30 pm and all the Members rush out—especially on a Thursday night—with the net result that people cannot get away before 10.30 pm because there is too much congestion. I should have thought that it would be better to relax the rule to 10 o'clock. There is all the talk about Jopling for Members. Why cannot a little committee get together in a huddle to sort out the matter, and then I would not have to speak until 10.30 pm?

Mr. Deputy Speaker: I am grateful to hon. Members for raising the point of order. I shall bring it to the attention of the relevant authorities.

Children's Homes (Streatham)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Andrew Mitchell.]

Mr. Keith Hill: I am grateful to Madam Speaker for selecting my subject for the Adjournment debate this evening.
I welcome the opportunity to bring directly to the Minister's attention the problems that are being experienced by my constituents in the Greyhound lane area of Streatham arising from the concentration and proliferation of private children's homes in the locality.
In recent months, residents have suffered entirely unacceptable levels of crime and disturbance in the vicinity. Shops and homes have been burgled. local residents have been attacked and robbed in the streets, shop windows and other premises' windows have been wilfully smashed. Public disturbances in the form of fighting in the streets have occurred, passers-by have been subject to various kinds of harassment such as verbal abuse and jostling, and a local shopkeeper has even had a brick thrown at her.
Local residents, and especially those living in Greyhound lane and in the adjacent Barrow, Pathfield, Westwell and Stanthorpe roads, have described their predicament to me as "a reign of terror". They have felt themselves to be "under siege". The situation threatens the stability of the community and raises community tensions.
Although it has worsened recently, this unfortunate state of affairs is not new. In the view of many residents, the growing incidence of crime dates back some five years. Regrettably, it dates back to the first appearance in the locality of private children's homes, housing, among others, young people designated as hard to control, persistent offenders and those with considerable behavioural problems. It is not my wish to suggest that all, or even most, of the young people in the homes are responsible for the difficulties that have occurred. I know that many of them are highly vulnerable. Many have been subject to various kinds of abuse and some are often refugees who have undergone the most dreadful experiences in their young lives.
I am also aware that we live in an ever more lawless society and that Streatham, alas, is no exception, but the relationship between rising crime and the growth of such private homes in the area is too great to be coincidental. In any case, local residents know who the perpetrators of crime have been and where they live. They have seen incidents with their own eyes. I have in my possession detailed diaries of the most appalling disturbances that have been experienced by those living close to such homes. I name no names and give no addresses, for obvious reasons.
Police records link crimes to a hard core of the residents of the homes. There is now a general consensus in Streatham among the police, the local authority—Lambeth—and the local community that the concentration of such homes is excessive, that more rigorous regulation is essential, that the further proliferation of such homes would be a major threat to the well-being of the community and that firm action is now required to check the proliferation.
As the Minister is well aware, the law draws a sharp distinction between the powers to regulate so-called larger

homes, which have four or more residential young people in care, and the regulation of small or satellite homes, which have fewer than four residents.

Mr. Bernie Grant: Will my hon. Friend give way?

Mr. Hill: I am sorry, no.
There are three main homes in the Greyhound lane area—those run by the Ebony, Omega and Vassel companies. I understand that those homes are capable of housing up to 24 young people between them. Planning permission is obviously required for the establishment of such homes. Frankly, it is a matter for considerable regret that a concentration of homes housing disturbed young people should have been allowed to develop in such a confined area.
Under the terms of the Children Act 1989, those main homes are in the process of being registered by the local authority. That means that the local authority will assess them in terms of staff ratios and rosters for supervision, on the suitability of premises—not least in relation to health and safety requirements—on policies and procedures, on administration and records and also on the qualifications and backgrounds of proprietors, managers and staff, including criminal records.
Unfortunately, the full rigour of that assessment will be limited by the fact that the three main homes in question were established before the coming into effect of the Children Act. I do not intend to speculate whether that was designed to escape the full requirements of registration. As a consequence, however, under the Government's guidelines, those homes are permitted a period of up to seven years before they have to comply in full with the maximum standards of staff qualifications in terms of social or psychiatric work or educational experience.
I believe that such flexibilty is a matter for regret, but, within those restrictions, I am sure that Lambeth will want to impose the most rigorous requirements for those homes before registration is completed by March this year. If they do not match up to the requirements, they should be closed.
I gather that Lambeth social services is responsible for the placement of five only of the young people in the main homes. I cannot understand how other authorities as far away as Brent, Tower Hamlets, Kensington and Camden can justify placing young people in the homes at such a long distance from their own localities. Those young people have no links or identity with the Streatham area. How can they be encouraged to resume a reasonable life in society in such circumstances? How, in all honesty, can there be any serious supervision of them by local social services departments at such a distance?
I appeal to other London authorities to reconsider their placement policies, especially when in practice they are placing young people in what has become a criminal environment. I hope that the Minister will support that appeal. At least the larger homes are subject to scrutiny under the registration procedure and their establishment is subject to planning permission. I sincerely trust that no further permissions will be granted in Streatham.
What gives rise to great anxiety among local residents, however, is the threat of the growth of small or satellite children's homes in the vicinity. Already the Ebony company runs three small units in Greyhound lane and Barrow road, and the Vassel company, based in Greyhound lane, runs a satellite unit a mile away, in Baldry gardens.
Local residents and councillors suspect that four more houses in the neighbourhood may have been purchased for further openings.
Unlike the larger homes, those small homes, because they have fewer than four young people as residents, fall outside the requirements for inspection and registration under the Children Act. They are therefore not subject to any scrutiny by the local authority with regard to standards of staffing, supervision or health and safety requirements.

Mr. Bernie Grant: Will my hon. Friend give way?

Mr. Hill: I am afraid that time prevents me from taking an intervention.
The local authority simply does not have the power to act. Equally, because proprietors describe those homes as fostering-type residences, the homes are deemed for planning purposes as single family dwelling homes and are not, therefore, subject to planning consent. A loophole in the law is being exploited. They are not family homes; they are residential institutions and should be treated as such. That is why the schedule in part C of the Town and Country Planning (Use Classes) Order 1987 should be amended to bring premises of that type under planning control. I very much hope that the Minister will make such a recommendation to his colleagues in the Department of the Environment.
By contrast, as the law stands at present, there is in principle nothing to prevent an entire street turning to that type of use. I do not, of course, suggest that that is likely to happen. Nevertheless, we should be in no doubt about how attractive opening small homes is to private proprietors.
With private children's homes of any size, we are talking big money. Proprietors charge between £650 and £950 per young person per week for placements, and the more challenging the young person, the higher the fee. We know that private companies are advertising their Streatham homes as suitable for young people with behavioural problems. If a private company can get away with opening a small home without having to apply for planning consent, with no inspection requirement and no systematic check on the quality of staff or supervision, the temptation is obvious.
I make no comment on the quality of staffing or supervision provided by Ebony, but I am informed that, as well as its three satellite units in Streatham, it operates four small units in Croydon and eight in Merton. That is big business by any standards. I also understand that Lambeth refuses to place any young persons in any of the small homes in Streatham, and has appealed to other London boroughs to reconsider their placement policies.
The Minister cannot claim to be unaware of the anxieties that have arisen about the growing numbers of small private children's homes. My hon. Friend the Member for Stockport (Ms Coffey), who is a former social worker and therefore has special expertise, has tabled an early-day motion on the subject, and I understand that she has had several meetings with the Minister to pursue the matter. She has now given notice that she will introduce a ten-minute Bill, of which I am a sponsor, in early February. I gather that, when the Minister met my hon. Friend, he asked for evidence of wider concern about the issue. I am now supplying that.
In any case, the Minister must be aware that, in May last year, the London heads of inspection, the council officers with responsibility for the registration of children's homes, wrote to the social services inspectorate to highlight various concerns about small children's homes. I understand that the overwhelming majority of representations that the Government have received have favoured the regular inspection and registration of such homes, as under the Children Act 1989. However, the Minister has apparently chosen to ignore them, and his circular, published in August, responded instead with what I gather is known as the "lighter touch" approach.
That means that, although local authorities have the responsibility to register such homes, they will not have the right to inspect. All responsibility for deciding on the suitability of the home will rest upon initial pre-placement visits by social workers from placing authorities, and thereafter upon annual visits by those individual social workers.
The drawbacks to the "light touch" approach are obvious. No generally recognised standards of care will apply. If an authority has good cause not to place, there will be no mechanism for communicating reservations to others. It is unreasonable to expect an individual social worker to have all the skills necessary to assess general standards of premises, policies and procedures, staffing, services and facilities. Furthermore, I understand that, because of a dispute about costs between the Department of Health and the Home Office, there is still no facility for police checks on the records of staff and proprietors.
Of course I realise that a Conservative Government will have an ideological commitment to deregulation—but we are talking about the lives and futures of young people, and the quality of life of many local residents in the surrounding communities. Normal arguments about deregulation cannot possibly apply in such circumstances.
I realise, too, that the Government have an ideological commitment to the private sector. No one disputes that there may be a proper role for privately run children's homes, but the children and the local communities should come before profit. What is the special advantage of the private management of such homes when private proprietors have no charter, no requirement for professional qualifications and no professional association?
Why cannot we have the same arrangements for small children's homes as for small adult homes with fewer than four residents? After all, the Government extended the requirement for the registration and inspection of small adult homes this year under the Registered Homes (Amendment) Act 1991. If it is appropriate for adult homes, why is it not for children's homes?
The case for the registration of such homes under the Children Act 1989 is crystal clear. That would help to ensure that such homes are properly run. There is an equally compelling case for bringing those small homes under proper planning control. That would help to prevent excessive concentration in particular localities. Without such measures, the future of the young people concerned and the balance and the well-being of a community such as that in the Greyhound lane area of my constituency may be even further threatened.
I hope that the Minister has listened carefully to my words and that he will act forthwith.

The Parliamentary Under-Secretary for Health (Mr. John Bowls): I congratulate the hon. Member for Streatham (Mr. Hill) on having the good fortune to secure this debate at long last. We both sat through the night before Christmas hoping that the subject would be on the agenda, but the procedures of the night precluded that on that occasion. He referred to one or two matters which relate to my hon. and right hon. Friends in the Department of the Environment. I shall pass his comments on to them, and no doubt they will take notice of what he has said.
The hon. Gentleman also referred to the meeting that I had with the hon. Member for Stockport (Ms Coffey). As he said, that was at the time when we had just issued the circular. We said that we would wait and see how that turned out and that we would look carefully at any further evidence. I said that I would listen carefully, and I have listened carefully tonight and will keep an open mind about some of the points that he has made.
Let me put the issue into context. Children's homes have to deal with a range of young people who are there for a number of different reasons, and some of them would tax the skills and the ability of any of us to care for and control children. There have, of course, been examples, some notorious, of residential child care staff abusing the responsibility that they have for the children in their care, but let me say at once that the staff have a job that can be rewarding and is almost certainly exacting and difficult.
We should also recognise that children and young people who, for whatever reason, cannot be brought up by their parents in their own home have, by definition, problems in life with which they have to come to terms, and to be helped so to do. We must understand the distress that can sometimes be caused to residents living in the vicinity of children's homes when discipline in those homes breaks down. As the hon. Gentleman has pointed out, there have been problems of that nature in his constituency, and I will return to that matter in a moment.
The problems of residential child care have for some time been exercising all those concerned with policy and provision. The pindown revelations were followed by the Utting report "Children in the Public Care". The Frank Beck trial was followed by the Warner inquiry and its report on the selection of staff "Choosing with Care".
We appointed, as the hon. Gentleman may know, a children's residential care support force under the chairmanship of Adrianne Jones, former director of social services in Birmingham. The support force is working with local authorities and homes to develop collaborative approaches to planning and delivery of care and will work on the improvement of practice and of management. The support force will also work on the development of a code of employment practice.
I believe that one will not have well-run children's homes or good child care generally until and unless there are staff who are trained to professional standards of care and common sense. A large number of residential child care staff have benefited from additional training provided under the Department of Health's annual £30 million training support grant. Of that, £4 million is specifically for the residential child care initiative, under which 130 staff received training last year and the same number this year. We can never be complacent, but we can reasonably claim to be giving appropriately high priority to measures to improve standards of residential child care.
The subject matter of the debate is the regulation of private and voluntary children's homes. Private children's homes in which four or more children are accommodated are required under the Children Act, as the hon. Gentleman said, to register with local authorities. For historical reasons, voluntary children's homes register with the Department of Health, but to the same standards, on which they are inspected by the social services inspectorate.
The children's homes regulations govern the conduct of private, voluntary and local authority children's homes. The regulations require adequate numbers of appropriately qualified staff and suitable accommodation, which includes sufficient washing, bathing and lavatory facilities, adequate heating, decoration and maintenance, adequate laundering arrangements, and a telephone that can be used by the children to make and receive calls in private.
The regulations prohibit the use of physical punishment, deprivation of food or drink, and restriction on contacts with parents whether as punishment or otherwise. Food must be nutritious and a choice is expected to be provided, as far as reasonably practicable, for each main meal.
There are also children's homes regulations governing the administration and registration of the homes. Local authorities are required to visit private and voluntary children's homes regularly within specified periods in particular circumstances. Organisations responsible for private and voluntary homes are required to arrange monthly visits to the homes by a senior member of the organisation.
In addition, the arrangements for placement of children regulations require a written care plan to be prepared and maintained in respect of each child. The plan must cover the arrangements for contact with the family, arrangements for the child's health and education, and arrangements for preparing the child for when he or she leaves the home and, in the case of a child looked after by a local authority, when the child will cease to be looked after.
The review of children's cases regulations require the case of each child in a home to be reviewed formally at six-monthly intervals. All the matters covered in the care plan are included in this review, and formal records of reviews have to be maintained.
The representations procedure regulations for children require local authorities to provide complaints procedures with an independent element in respect of all children they accommodate in homes, and private and voluntary homes are required to do the same in respect of any children placed with them other than by local authorities.
It is clear that the regulations governing children's homes, and the care of the children accommodated in them, are very comprehensive and rigorous. That is as it should be.
Children's homes regimes should be geared to enabling children to overcome the disadvantages of their early life that have resulted in their being there. Children in homes also need to be protected from neglect or exploitation. Like any other children, they need to be brought up in an atmosphere of love, understanding and discipline.
The family provides the essential environment for bringing up children, and a children's home has to be a family environment for them. Children need care, compassion and common sense. They need to be brought up in an affectionate and responsible family atmosphere. Such surroundings provide the best environment for their emotional, physical and developmental needs, and prepare them to pass on family values to their own children.
The Children Act 1989 is among the most comprehensive legislation in the world for the care and protection of children. It asserts their right to be heard, their need for parents, and the continuing responsibility of their parents towards them, based on love and care. That includes instilling respect, responsibility and knowing right from wrong.

Mr. Bernie Grant: Is the Minister aware that he is discussing 15 black children, and that the homes are owned by black people? The people in those homes regard the matter as nothing other than a racist attack on the children and on the homes themselves. Does the Minister agree that the so-called evidence that my hon. Friend the Member for Streatham (Mr. Hill) has given has amounted to nothing? If crimes have been committed by those children, they should have been enumerated. That would have given a different picture altogether.

Mr. Bowis: The hon. Gentleman disagrees with his own hon. Friend. I have to leave them to sort out their dispute. I hope that the hon. Member for Tottenham (Mr. Grant) will accept that racism has no part in my beliefs and that there is no racism in what I am saying in response to the problems that have been raised with me.
As well as all the regulations that I have referred to, voluminous guidance has been issued by the Department of Health on the Children Act and on the regulations. The guidance advises those running homes that good relations with neighbours are important. Children living in children's homes have as much right to live in a neighbourhood as other residents. But, by the same token, the staff and children in a home have responsibilities as good neighbours, and due consideration must be given to neighbours' privacy, property and way of life.
I am aware that there have been reports recently of an increase in street robberies in the hon. Gentleman's constituency and that a link has been suggested with an increase in the number of children's homes in the area. I understand that there has been considerable local concern about this, and officers of Lambeth social services department have met the proprietors of the homes and Streatham police.
The proprietors gave an assurance that they would not seek to open any further small homes in the area, and will establish a procedure for dealing with complaints from local residents. The proprietors were asked to review their admissions criteria and procedures for reporting absconders. A meeting has taken place involving the homes' proprietors and local residents at which the proprietors heard the residents' views and reported on progress made.
I understand that the London borough of Lambeth considers that some young offenders have been inappropriately placed in these homes by local authorities and there should be regulations governing these small homes.
Where three or fewer children are accommodated in an establishment under the Children Act, it cannot be a private children's home. If there is a single named carer for the children, the fostering regulations apply. However, when a small home is run by an organisation with staff on rosters and shifts, the fostering provisions in the Children Act do not apply. I understand that this is the situation with the establishments in Streatham about which there is concern.
The children in such homes are, I understand, nearly all placed in the homes by local authorities. Therefore, although the children's homes regulations do not apply, the placement, representations and review regulations to which I referred earlier do apply.
In response to concerns that arose earlier in the north-west of England, my Department issued a circular in August 1993 which reminded local authorities of their responsibilities under the placement, representations and review regulations, and provided detailed practice guidance for use were children are placed in small homes. I have decided to publish the report of an SSI study of small homes, and I shall place a copy in the Library.
Children in such homes should be visited by a social worker at intervals of not more than three months. Similar standards to those required by the Children Act are advised. In addition, I should make it clear that the local authority in whose area one of the small homes is established has an absolute right and duty to go in and take any necessary action, including removing children, if it is clear that children are not being properly cared for or are at risk.
The circular asked local authorities to extend police checks to prospective staff of small homes who will have direct responsibility for care of children looked after by local authorities. The circular reminds local authorities that they have full responsibility to ensure that police checks have been conducted before they place any child.
I shall keep the question of further regulation under review as we see how the guidance recently issued takes effect. For the time being, I am not convinced that greater regulation of the care of these young people is needed. Their welfare is already safeguarded by the existing regulations in so far as it is possible for that to be achieved by regulations.
Staff looking after the children have ample guidance on how they should care for and control them, including the guidance entitled "Permissible Forms of Control in Children's Residential Care" issued by my Department in April. It is, of course, for home managers to abide by that, and for local authorities to ensure that the children they have placed are being looked after properly and, that homes in that area are being run properly.
I hope that the hon. Gentleman and his constituents will be reassured that the arrangements that are in place for the regulation of children's homes and for the care and control of the children are more than adequate. I hope that the London borough of Lambeth will take steps to respond to the complaints of residents in Streatham to produce an improvement in the situation. I also hope that the care and control of the children in the children's homes about which the hon. Gentleman has been concerned will be such that the longer-term outcome for the children in the homes will be enhanced, and that they emerge as good and responsible citizens, who in turn will become good parents for their own children.

Mr. Bernie Grant: I did not intend to speak, but I was concerned at the way in which my hon. Friend the Member for Streatham (Mr. Hill) introduced the debate. He talks about evidence, but gives us none. I understand that there are 14 or 15 black children involved, and that the homes are owned by black proprietors. I also


understand that the police and the assistant director of social services in Lambeth are satisfied with what is happening.
In raising this matter in the way in which he has done, my hon. Friend is casting aspersions on the behaviour and the management ability of the proprietors of those homes. I was absolutely astounded when I was told that my hon. Friend had not even bothered to speak to any of the proprietors or to the children themselves in his constituency. That is an abrogation of his responsibility as a Member of Parliament.
I do not doubt that a number of residents in that area may be concerned about the behaviour of those young

children. I believe that it is the job of the Member of Parliament to speak to everybody concerned, including the children and the proprietors, before he comes to a decision and talks about a reign of terror. I hope that my hon. Friend will meet those people, who have had to come to me. I do not know anything about the situation in Streatham—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Eleven o'clock.